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General NPI Number Information
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NPI Number | 1316482961
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Entity Type | Organization
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Legal Business Name | ABRIDGED PSYCHOLOGY, PLLC
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Dates
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Enumeration Date | 01/05/2017
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | 647 FRANKLIN AVE SUITE: LL4
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City | GARDEN CITY
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State | NY
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Zip | 11530-5746
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Country | US
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Telephone | 516-798-4070
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Fax |
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Provider Business Mailing Address
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Address Line | 205 MINEOLA BLVD APT. 4F
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City | MINEOLA
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State | NY
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Zip | 11501-2550
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Country | US
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Telephone | 516-698-8178
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/OWNER
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Name | LAURA BONOMO
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Credential | PH.D.
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Telephone | 516-798-4070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 007280
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 021509
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 016588
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 090586
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 011068
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License Number State | NY
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