| Sole Proprietor | |
|
610 Willis Ave Apt 1f Williston Park NY 11596-1221 | |
| (516) 770-2383 | |
| Not Available |
| Full Name | Sole Proprietor |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 610 Willis Ave Apt 1f, Williston Park, New York |
| Authorized Official Name and Position | Brendan Michael Canavan (ABSS) |
| Authorized Official Contact | 5167702383 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sole Proprietor 610 Willis Ave Apt 1f Williston Park NY 11596-1221 Ph: (516) 770-2383 | Sole Proprietor 610 Willis Ave Apt 1f Williston Park NY 11596-1221 Ph: (516) 770-2383 |
| NPI Number | 1891187852 |
|---|---|
| Provider Enumeration Date | 02/28/2015 |
| Last Update Date | 02/28/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891187852 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 437022101 (New York) | Primary |
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