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General NPI Number Information
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NPI Number | 1699679688
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Entity Type | Organization
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Legal Business Name | UNLEASHED POTENTIAL PSYCHOTHERAPY LCSW PLLC
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Dates
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Enumeration Date | 10/05/2026
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Last Update Date | 10/05/2026
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Provider Practice Location Address
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Address Line | 3 MELWOOD DR
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City | COMMACK
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State | NY
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Zip | 11725-5610
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Country | US
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Telephone | 631-432-8897
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Fax |
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Provider Business Mailing Address
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Address Line | 169 COMMACK RD # 1015
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City | COMMACK
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State | NY
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Zip | 11725-3442
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Country | US
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Telephone | 631-432-8897
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JESSICA ANN REBELO
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Credential | LCSW
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Telephone | 631-432-8897
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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 |
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License Number State | NULL
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