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General NPI Number Information
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NPI Number | 1598413510
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Entity Type | Organization
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Legal Business Name | ISLAND PSYCHOLOGICAL SERVICES PC
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Dates
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Enumeration Date | 03/17/2022
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Last Update Date | 03/17/2022
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Provider Practice Location Address
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Address Line | 410 LANDING AVE
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City | SMITHTOWN
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State | NY
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Zip | 11787-1197
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Country | US
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Telephone | 631-229-6942
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 408
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City | SMITHTOWN
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State | NY
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Zip | 11787-0408
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Country | US
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Telephone | 631-229-6942
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | DR. CHRISTINE SPENCE
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Credential | PSY.D
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Telephone | 917-443-7295
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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 |
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License Number State |
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