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General NPI Number Information
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NPI Number | 1841648920
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Entity Type | Organization
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Legal Business Name | CROSSROADS COUNSELING CENTER, INC.
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Dates
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Enumeration Date | 05/30/2016
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Last Update Date | 05/30/2016
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Provider Practice Location Address
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Address Line | 440 FURROWS RD 2ND FL.
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City | HOLBROOK
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State | NY
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Zip | 11741-2700
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Country | US
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Telephone | 631-714-5407
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Fax |
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Provider Business Mailing Address
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Address Line | 440 FURROWS RD 2ND FL.
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City | HOLBROOK
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State | NY
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Zip | 11741-2700
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Country | US
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Telephone | 631-714-5407
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | JAY HART
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Credential |
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Telephone | 631-714-5407
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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 | 080259
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License Number State | NY
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