Provider Demographics
NPI:1689950305
Name:LONG ISLAND COUNCIL ON ALCOHOLISM AND DRUG DEPENDENCE
Entity Type:Organization
Organization Name:LONG ISLAND COUNCIL ON ALCOHOLISM AND DRUG DEPENDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECEUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-747-2606
Mailing Address - Street 1:114 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4420
Mailing Address - Country:US
Mailing Address - Phone:516-747-2606
Mailing Address - Fax:516-747-0714
Practice Address - Street 1:114 OLD COUNTRY RD
Practice Address - Street 2:SUITE 114
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4420
Practice Address - Country:US
Practice Address - Phone:516-747-2606
Practice Address - Fax:516-747-0714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health