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General NPI Number Information
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NPI Number | 1922134253
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Entity Type | Organization
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Legal Business Name | WANTAGH PSYCHOLOGICAL COUNSELING SERVICES PC
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 04/25/2011
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Provider Practice Location Address
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Address Line | 1926 OAKLAND AVE
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City | WANTAGH
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State | NY
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Zip | 11793-3610
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Country | US
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Telephone | 516-781-0457
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Fax | 516-781-0457
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Provider Business Mailing Address
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Address Line | 1926 OAKLAND AVE
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City | WANTAGH
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State | NY
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Zip | 11793-3610
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Country | US
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Telephone | 516-781-0457
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Fax | 516-781-0457
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. MARK H PERLMAN
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Credential | PHD
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Telephone | 516-781-0457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 10383
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License Number State | NY
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