Provider Demographics
NPI:1376878892
Name:BABYLON COUN,SELING WELLNESS SERVICES, LCSW, PC
Entity Type:Organization
Organization Name:BABYLON COUN,SELING WELLNESS SERVICES, LCSW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHEDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-482-8010
Mailing Address - Street 1:170 LITTLE EAST NECK RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-7742
Mailing Address - Country:US
Mailing Address - Phone:631-482-8010
Mailing Address - Fax:631-482-8012
Practice Address - Street 1:170 LITTLE EAST NECK RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-7742
Practice Address - Country:US
Practice Address - Phone:631-482-8010
Practice Address - Fax:631-482-8012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0763841041C0700X
NY0759601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty