Provider Demographics
NPI:1407497191
Name:NORTH SHORE NEUROFEEDBACK
Entity Type:Organization
Organization Name:NORTH SHORE NEUROFEEDBACK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCASCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-903-4599
Mailing Address - Street 1:124 WOOLSEY AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-1808
Mailing Address - Country:US
Mailing Address - Phone:516-903-4599
Mailing Address - Fax:
Practice Address - Street 1:480 FOREST AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:LOCUST VALLEY
Practice Address - State:NY
Practice Address - Zip Code:11560-2151
Practice Address - Country:US
Practice Address - Phone:516-903-4599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty