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General NPI Number Information
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NPI Number | 1568903193
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Entity Type | Organization
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Legal Business Name | LONG ISLAND COGNITIVE BEHAVIORAL PSYCHOLOGY
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Dates
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Enumeration Date | 03/15/2017
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Last Update Date | 03/15/2017
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Provider Practice Location Address
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Address Line | 283 COMMACK RD SUITE LL1
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City | COMMACK
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State | NY
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Zip | 11725-6021
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Country | US
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Telephone | 631-896-9216
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Fax |
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Provider Business Mailing Address
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Address Line | 283 COMMACK RD SUITE LL1
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City | COMMACK
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State | NY
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Zip | 11725-6021
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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 | PSYCHOLOGIST/OWNER
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Name | DR. IRENE MILONAS
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Credential | PSY.D.
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Telephone | 631-896-9216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0215741
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License Number State | NY
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