| Eastern Suffolk Counseling Lcsw Pllc | |
|
551 N Country Rd Suite 203 Saint James NY 11780-1445 | |
| (631) 504-2102 | |
| Not Available |
| Full Name | Eastern Suffolk Counseling Lcsw Pllc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 551 N Country Rd, Saint James, New York |
| Authorized Official Name and Position | Richard Girard-domena (CLINICAL DORECTOR) |
| Authorized Official Contact | 6315042102 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastern Suffolk Counseling Lcsw Pllc Po Box 150 Centereach NY 11720-0150 Ph: (631) 504-2102 | Eastern Suffolk Counseling Lcsw Pllc 551 N Country Rd Suite 203 Saint James NY 11780-1445 Ph: (631) 504-2102 |
| NPI Number | 1639529266 |
|---|---|
| Provider Enumeration Date | 06/14/2016 |
| Last Update Date | 06/14/2016 |
| Medicare PECOS PAC ID | 1254624422 |
|---|---|
| Medicare Enrollment ID | O20160726000858 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639529266 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | R078941-1 (New York) | Primary |
| Provider Name | Richard Girard-domena |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326369257 PECOS PAC ID: 8022142058 Enrollment ID: I20120215000180 |
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