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General NPI Number Information
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NPI Number | 1215025366
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Entity Type | Organization
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Legal Business Name | PORT COUNSELING CENTER INC
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 225 MAIN ST
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-3211
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Country | US
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Telephone | 516-767-1133
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Fax | 516-767-3680
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Provider Business Mailing Address
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Address Line | 225 MAIN ST
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-3211
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Country | US
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Telephone | 516-767-1133
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Fax | 516-767-3680
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | AGNES LASETCHUK
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Credential | CSW
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Telephone | 516-767-1133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | NY
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