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General NPI Number Information
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NPI Number | 1215029004
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Entity Type | Organization
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Legal Business Name | TOWN OF ISLIP
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 09/23/2008
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Provider Practice Location Address
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Address Line | 452 SUFFOLK AVE
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City | BRENTWOOD
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State | NY
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Zip | 11717
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Country | US
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Telephone | 631-436-6065
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Fax | 631-436-6068
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Provider Business Mailing Address
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Address Line | 452 SUFFOLK AVE
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City | BRENTWOOD
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State | NY
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Zip | 11717
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Country | US
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Telephone | 631-436-6065
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Fax | 631-436-6068
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Authorized Official
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Title or Position | DIRECTOR
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Name | DELORES BOCKLET
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Credential |
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Telephone | 631-224-5330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 091111083
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 080611082
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License Number State | NY
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