Provider Demographics
NPI:1073173811
Name:LONG ISLAND WELLNESS ASSOCIATES INC.
Entity Type:Organization
Organization Name:LONG ISLAND WELLNESS ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMARTINIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-509-0714
Mailing Address - Street 1:8 CAMELOT LN
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-3104
Mailing Address - Country:US
Mailing Address - Phone:631-509-0714
Mailing Address - Fax:
Practice Address - Street 1:8 CAMELOT LN
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-3104
Practice Address - Country:US
Practice Address - Phone:631-509-0714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health