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General NPI Number Information
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NPI Number | 1821419144
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Entity Type | Organization
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Legal Business Name | FIVE HARBORS PSYCHOLOGY, PLLC
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Dates
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Enumeration Date | 01/05/2014
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Last Update Date | 01/07/2014
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Provider Practice Location Address
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Address Line | 23 GREEN ST SUITE 203
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City | HUNTINGTON
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State | NY
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Zip | 11743-3336
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Country | US
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Telephone | 631-424-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 23 GREEN ST SUITE 203
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City | HUNTINGTON
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State | NY
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Zip | 11743-3336
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Country | US
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Telephone | 631-424-4600
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST/DIRECTOR
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Name | DR. JENNIFER KORNREICH
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Credential | PH.D.
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Telephone | 631-424-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 018847
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 018847
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License Number State | NY
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