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General NPI Number Information
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NPI Number | 1932230026
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Entity Type | Organization
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Legal Business Name | RESIDENTIAL EXPERIENCE IN ADULT LIVING, INC
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 08/25/2014
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Provider Practice Location Address
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Address Line | 55 N OCEAN AVE 2ND FLOOR
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City | FREEPORT
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State | NY
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Zip | 11520
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Country | US
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Telephone | 516-223-9570
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Fax | 516-223-8076
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Provider Business Mailing Address
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Address Line | 55 N OCEAN AVE 2ND FLOOR
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City | FREEPORT
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State | NY
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Zip | 11520
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Country | US
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Telephone | 516-223-9570
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Fax | 516-223-8076
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. KATHLEEN M MALIZIA
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Credential | LMSW, MS
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Telephone | 516-223-9570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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