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General NPI Number Information
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NPI Number | 1326711888
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Entity Type | Organization
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Legal Business Name | CENTER ROCK MENTAL HEALTH COUNSELING
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Dates
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Enumeration Date | 07/29/2021
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 16 MIDDLE NECK RD STE 537
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City | GREAT NECK
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State | NY
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Zip | 11021-2357
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Country | US
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Telephone | 917-912-2925
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Fax |
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Provider Business Mailing Address
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Address Line | 105 W HUDSON ST
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City | LONG BEACH
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State | NY
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Zip | 11561-1924
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Country | US
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Telephone | 917-912-2925
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FANEGIE BADETTE
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Credential | LMHC
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Telephone | 917-912-2925
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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 |
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License Number State |
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