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NPI Code Detail

MEDICARE: LONG ISLAND EMDR LCSW P.C.

MEDICARE: LONG ISLAND EMDR LCSW P.C.
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1356977177
Entity Type Code : Organization
Provider Name (Legal Business Name) : LONG ISLAND EMDR LCSW P.C.
Provider Business Mailing Address
First Line : 4109 SUNRISE HWY
Second Line :
City : BOHEMIA
State : NY
Zip : 11716-4600
Country : US
Telephone Number : 631-503-1539
Fax Number :
Provider Business Practice Location Address
First Line : 4109 SUNRISE HWY
Second Line :
City : BOHEMIA
State : NY
Zip : 11716-4600
Country : US
Telephone Number : 631-503-1539
Fax Number :
Authorized Official
Title or Position : FOUNDER AND LCSW
Name : JAMIE VOLLMOELLER
Credential : LCSW
Telephone Number : 631-503-1539
Provider Enumeration Date : 03/13/2020
Last Update Date : 02/26/2026

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