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General NPI Number Information
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NPI Number | 1861766123
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Entity Type | Organization
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Legal Business Name | EPPS THERAPEUTIC PARTNERS CO.
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Dates
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Enumeration Date | 03/05/2012
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Last Update Date | 03/05/2012
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Provider Practice Location Address
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Address Line | 149 EVERGREEN AVE
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City | BRENTWOOD
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State | NY
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Zip | 11717-4100
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Country | US
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Telephone | 631-435-0421
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Fax | 631-435-0421
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Provider Business Mailing Address
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Address Line | 149 EVERGREEN AVE
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City | BRENTWOOD
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State | NY
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Zip | 11717-4100
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Country | US
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Telephone | 631-435-0421
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Fax | 631-435-0421
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Authorized Official
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Title or Position | CEO
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Name | MS. DEBORAH JAMES EPPS
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Credential | LCSW-R, BCD
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Telephone | 631-435-0421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | R033117
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License Number State | NY
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