Provider Demographics
NPI:1568903193
Name:LONG ISLAND COGNITIVE BEHAVIORAL PSYCHOLOGY
Entity Type:Organization
Organization Name:LONG ISLAND COGNITIVE BEHAVIORAL PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILONAS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:631-896-9216
Mailing Address - Street 1:283 COMMACK RD
Mailing Address - Street 2:SUITE LL1
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-6021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:283 COMMACK RD
Practice Address - Street 2:SUITE LL1
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-6021
Practice Address - Country:US
Practice Address - Phone:631-896-9216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0215741103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty