Provider Demographics
NPI:1508242009
Name:QUEENS/LONG ISLAND COUNSELING SERVICES
Entity Type:Organization
Organization Name:QUEENS/LONG ISLAND COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MHC
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:PEARCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-993-6815
Mailing Address - Street 1:4343 BOWNE ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3039
Mailing Address - Country:US
Mailing Address - Phone:516-993-6815
Mailing Address - Fax:
Practice Address - Street 1:168 CONNECTICUT AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-1531
Practice Address - Country:US
Practice Address - Phone:516-993-6815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP95482101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty