Provider Demographics
NPI:1356016703
Name:LONG ISLAND CONSULTATION CENTER
Entity Type:Organization
Organization Name:LONG ISLAND CONSULTATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JENSYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUESANO
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:914-960-5756
Mailing Address - Street 1:19 FAITH LN
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-2528
Mailing Address - Country:US
Mailing Address - Phone:914-960-5756
Mailing Address - Fax:
Practice Address - Street 1:9131 QUEENS BLVD STE 222
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5511
Practice Address - Country:US
Practice Address - Phone:718-896-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty