Provider Demographics
NPI:1609404052
Name:FACCINI, LINO (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINO
Middle Name:
Last Name:FACCINI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-4610
Mailing Address - Country:US
Mailing Address - Phone:631-819-1192
Mailing Address - Fax:
Practice Address - Street 1:241 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-4610
Practice Address - Country:US
Practice Address - Phone:631-819-1192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011517103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY011517OtherNYS LICENSE