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General NPI Number Information
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NPI Number | 1174459267
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Entity Type | Organization
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Legal Business Name | CHERRY HAVEN WELLNESS
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Dates
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Enumeration Date | 06/18/2026
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Last Update Date | 06/18/2026
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Provider Practice Location Address
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Address Line | 100 CENTERSHORE RD
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City | CENTERPORT
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State | NY
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Zip | 11721-1527
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Country | US
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Telephone | 631-403-0282
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Fax | 631-350-0267
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Provider Business Mailing Address
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Address Line | 1 HEWITT SQ
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-2519
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Country | US
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Telephone | 631-403-0282
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Fax | 631-350-0267
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Authorized Official
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Title or Position | OWNER
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Name | JAMES MICHAEL CHERRY
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Credential | LCSW
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Telephone | 631-403-0282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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