Provider Demographics
NPI:1083718779
Name:SOUTHEAST NASSAU GUIDANCE CENTER INC.
Entity Type:Organization
Organization Name:SOUTHEAST NASSAU GUIDANCE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSALIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MIRABELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-221-3030
Mailing Address - Street 1:2146 JACKSON AVE
Mailing Address - Street 2:P.O. BOX 1037
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-2606
Mailing Address - Country:US
Mailing Address - Phone:516-221-3030
Mailing Address - Fax:516-221-4160
Practice Address - Street 1:2146 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-2606
Practice Address - Country:US
Practice Address - Phone:516-221-3030
Practice Address - Fax:516-221-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6801100A261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW02651Medicare PIN