Provider Demographics
NPI:1235564063
Name:BRESSINGHAM, JANICE (LCSW,CCM)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:BRESSINGHAM
Suffix:
Gender:F
Credentials:LCSW,CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11709-1300
Mailing Address - Country:US
Mailing Address - Phone:631-416-6745
Mailing Address - Fax:
Practice Address - Street 1:501 FRANKLIN AVE STE 300
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1655
Practice Address - Country:US
Practice Address - Phone:516-531-2001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0904131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical