Provider Demographics
NPI:1598840787
Name:TOWN OF SMITHTOWN HORIZONS COUNSELING CTR
Entity Type:Organization
Organization Name:TOWN OF SMITHTOWN HORIZONS COUNSELING CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ECONOMOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:CASAC,CPP
Authorized Official - Phone:631-360-7578
Mailing Address - Street 1:124 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2605
Mailing Address - Country:US
Mailing Address - Phone:631-360-7578
Mailing Address - Fax:631-360-7687
Practice Address - Street 1:124 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2605
Practice Address - Country:US
Practice Address - Phone:631-360-7578
Practice Address - Fax:631-360-7687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02773357Medicaid