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General NPI Number Information
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NPI Number | 1598140998
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Entity Type | Organization
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Legal Business Name | ALL ISLAND COUNSELING LCSW PC
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Dates
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Enumeration Date | 07/27/2015
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Last Update Date | 07/27/2015
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Provider Practice Location Address
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Address Line | 127 GATELOT AVE
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City | RONKONKOMA
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State | NY
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Zip | 11779-2266
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Country | US
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Telephone | 631-252-5740
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Fax | 631-743-9983
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Provider Business Mailing Address
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Address Line | 127 GATELOT AVE
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City | RONKONKOMA
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State | NY
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Zip | 11779-2266
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Country | US
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Telephone | 631-252-5740
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Fax | 631-743-9983
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOAN MARIE RYAN I
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Credential | LCSW-R
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Telephone | 631-252-5740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 077909
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License Number State | NY
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