Provider Demographics
NPI:1609923515
Name:NASSAU GUIDANCE COUNSELING & LICENSED CLINICAL SOCIAL WORK SERVICES PC
Entity Type:Organization
Organization Name:NASSAU GUIDANCE COUNSELING & LICENSED CLINICAL SOCIAL WORK SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DWYER
Authorized Official - Suffix:
Authorized Official - Credentials:LSCW
Authorized Official - Phone:516-826-4891
Mailing Address - Street 1:1262 POWELL AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-1811
Mailing Address - Country:US
Mailing Address - Phone:516-829-4891
Mailing Address - Fax:516-785-5698
Practice Address - Street 1:1262 POWELL AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-1811
Practice Address - Country:US
Practice Address - Phone:516-829-4891
Practice Address - Fax:516-785-5698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0261171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN70741Medicare ID - Type Unspecified