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General NPI Number Information
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NPI Number | 1427749688
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Entity Type | Organization
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Legal Business Name | CERULEAN WILLOW MENTAL HEALTH COUNSELING PLLC
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Dates
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Enumeration Date | 05/18/2023
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 1227 MAIN ST STE 302
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-2227
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Country | US
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Telephone | 631-512-3079
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 685
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City | OYSTER BAY
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State | NY
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Zip | 11771-0685
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | DAISY DENISE RODRIGUEZ
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Credential | LMHC
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Telephone | 631-512-3079
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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 |
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License Number State |
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Taxonomy #2
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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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