MEDICARE: INSTITUTE FOR EMOTIONAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1134686447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTITUTE FOR EMOTIONAL HEALTH

Provider Business Mailing Address
First Line	:	33 SOUTH ST
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-1714
Country	:	US
Telephone Number	:	516-640-9766
Fax Number	:	516-621-0036

Provider Business Practice Location Address
First Line	:	33 SOUTH ST
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-1714
Country	:	US
Telephone Number	:	516-640-9766
Fax Number	:	516-621-0036

Authorized Official
Title or Position	:	PSYCHOLOGIST/EXECUTIVE DIRECTOR
Name	:	DR. LEONARD T. GRIES
Credential	:	PH.D.
Telephone Number	:	516-621-0036

Provider Enumeration Date	:	02/22/2019
Last Update Date	:	02/22/2019

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