Provider Demographics
NPI:1457486938
Name:COUNSELING MEDIATION & FORENSIC SERVICES
Entity Type:Organization
Organization Name:COUNSELING MEDIATION & FORENSIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:STASSI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWR
Authorized Official - Phone:631-218-0962
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-0647
Mailing Address - Country:US
Mailing Address - Phone:631-218-0968
Mailing Address - Fax:631-567-5172
Practice Address - Street 1:30 FLOYDS RUN
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-2154
Practice Address - Country:US
Practice Address - Phone:631-218-0968
Practice Address - Fax:631-567-5172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN3W631Medicare ID - Type Unspecified