Provider Demographics
NPI:1114122991
Name:MENTAL HEALTH NURSE PRACTITIONER CONSULTATION SERVICES PC
Entity Type:Organization
Organization Name:MENTAL HEALTH NURSE PRACTITIONER CONSULTATION SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:BRIDGET
Authorized Official - Last Name:OBRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:NPP, APRN
Authorized Official - Phone:631-656-9761
Mailing Address - Street 1:637 VETERANS HWY
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4309
Mailing Address - Country:US
Mailing Address - Phone:631-656-9761
Mailing Address - Fax:631-656-9765
Practice Address - Street 1:637 VETERANS HWY
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4309
Practice Address - Country:US
Practice Address - Phone:631-656-9761
Practice Address - Fax:631-656-9765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400083363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty