Provider Demographics
NPI:1033279963
Name:COMMUNITY COUNSELING SERVICES OF WEST NASSAU, INC.
Entity Type:Organization
Organization Name:COMMUNITY COUNSELING SERVICES OF WEST NASSAU, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:F
Authorized Official - Last Name:LAFEMINA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:516-328-1717
Mailing Address - Street 1:340 DOGWOOD AVE
Mailing Address - Street 2:SUITE106
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3409
Mailing Address - Country:US
Mailing Address - Phone:516-328-1717
Mailing Address - Fax:516-328-1627
Practice Address - Street 1:340 DOGWOOD AVE
Practice Address - Street 2:SUITE106
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-3409
Practice Address - Country:US
Practice Address - Phone:516-328-1717
Practice Address - Fax:516-328-1627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171210724251S00000X
NYC151210724251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01013818Medicaid
NY51J002Medicare UPIN
NYW23221Medicare PIN