Provider Demographics
NPI:1114607884
Name:SABSHON, EILEEN GWEN
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:GWEN
Last Name:SABSHON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ORMOND ST
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6334
Mailing Address - Country:US
Mailing Address - Phone:631-834-5120
Mailing Address - Fax:
Practice Address - Street 1:534 BROADHOLLOW RD STE LL70
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3635
Practice Address - Country:US
Practice Address - Phone:631-861-3750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP118500101YM0800X
103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health