Provider Demographics
NPI:1275946493
Name:CJM COUNSELING LICENSED CLINICAL SOCIAL WORKERS P.C.
Entity Type:Organization
Organization Name:CJM COUNSELING LICENSED CLINICAL SOCIAL WORKERS P.C.
Other - Org Name:CJM COUNSELING LICENSED CLINICAL SOCIAL WORKERS P.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED CLINICAL SO
Authorized Official - Phone:631-252-5740
Mailing Address - Street 1:127 GATELOT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-2266
Mailing Address - Country:US
Mailing Address - Phone:631-252-5740
Mailing Address - Fax:631-743-9983
Practice Address - Street 1:145 HIGBIE LN
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-3236
Practice Address - Country:US
Practice Address - Phone:631-252-5740
Practice Address - Fax:631-743-6625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077909101YM0800X, 101YP2500X, 102L00000X, 103K00000X, 104100000X, 1041C0700X, 106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty