Provider Demographics
NPI:1558425231
Name:AVRAHAM CALEV ASSESSMENT AND COUNSELING CENTER OF LONG ISLAND
Entity Type:Organization
Organization Name:AVRAHAM CALEV ASSESSMENT AND COUNSELING CENTER OF LONG ISLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AVRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CALEV
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:631-361-7389
Mailing Address - Street 1:111 SMITHTOWN BYP
Mailing Address - Street 2:119
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2524
Mailing Address - Country:US
Mailing Address - Phone:631-361-7389
Mailing Address - Fax:631-246-5469
Practice Address - Street 1:111 SMITHTOWN BYP
Practice Address - Street 2:119
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2524
Practice Address - Country:US
Practice Address - Phone:631-361-7389
Practice Address - Fax:631-246-5469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010953261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01344710Medicaid
NYR52155Medicare UPIN
NYV6B372Medicare ID - Type Unspecified