Provider Demographics
NPI:1134660624
Name:LONG ISLAND PSYCHOTHERAPY & COUNSELING, LCSW P.C.
Entity Type:Organization
Organization Name:LONG ISLAND PSYCHOTHERAPY & COUNSELING, LCSW P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:
Authorized Official - Last Name:IDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-772-8373
Mailing Address - Street 1:8 DALTON LN
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-3909
Mailing Address - Country:US
Mailing Address - Phone:347-772-8373
Mailing Address - Fax:
Practice Address - Street 1:97 POWERHOUSE RD STE 104
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2046
Practice Address - Country:US
Practice Address - Phone:347-772-8373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0638371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty