Provider Demographics
NPI:1558667600
Name:PLAINVIEW OLD BETHPAGE YOUTH ACTIVITIES COUNCIL
Entity Type:Organization
Organization Name:PLAINVIEW OLD BETHPAGE YOUTH ACTIVITIES COUNCIL
Other - Org Name:REFLECTION COUNSELING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-576-3120
Mailing Address - Street 1:202 TERMINAL DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-2318
Mailing Address - Country:US
Mailing Address - Phone:516-576-6120
Mailing Address - Fax:516-576-3446
Practice Address - Street 1:202 TERMINAL DR
Practice Address - Street 2:STE. 3
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-2318
Practice Address - Country:US
Practice Address - Phone:516-576-3120
Practice Address - Fax:516-576-3446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070611542101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02861145Medicaid