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General NPI Number Information
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NPI Number | 1972328201
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Entity Type | Organization
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Legal Business Name | NEW YORK YOUTH LCSW SERVICES, PLLC
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 85 WHEELER RD
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City | CENTRAL ISLIP
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State | NY
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Zip | 11722-2028
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Country | US
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Telephone | 814-661-6870
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Fax |
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Provider Business Mailing Address
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Address Line | 121 CHANLON RD
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City | NEW PROVIDENCE
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State | NJ
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Zip | 07974-1543
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Country | US
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Telephone | 973-299-9954
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Fax |
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Authorized Official
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Title or Position | COMPLIANCE OFFICER
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Name | AMY BUEHRER
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Credential | LSW
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Telephone | 814-661-6870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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