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General NPI Number Information
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NPI Number | 1508548272
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Entity Type | Organization
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Legal Business Name | STONYBROOK FOUNDATION
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Dates
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Enumeration Date | 08/02/2023
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 2755 E DESERT INN RD STE 270
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City | LAS VEGAS
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State | NV
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Zip | 89121-3690
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Country | US
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Telephone | 725-203-0536
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Fax |
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Provider Business Mailing Address
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Address Line | 2755 E DESERT INN RD STE 155
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City | LAS VEGAS
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State | NV
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Zip | 89121-3637
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Country | US
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Telephone | 725-203-0536
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | WINNIE BRISSEETT
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Credential |
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Telephone | 202-430-6559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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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 |
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Taxonomy #4
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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