Provider Demographics
NPI:1346223252
Name:HEART & SOUL COMMUNITY COUNSELING
Entity Type:Organization
Organization Name:HEART & SOUL COMMUNITY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CALABRESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-321-7011
Mailing Address - Street 1:17 FORDHAM RD
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-5803
Mailing Address - Country:US
Mailing Address - Phone:631-321-7011
Mailing Address - Fax:631-669-8532
Practice Address - Street 1:17 FORDHAM RD
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-5803
Practice Address - Country:US
Practice Address - Phone:631-321-7011
Practice Address - Fax:631-669-8532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty