Provider Demographics
NPI:1700382603
Name:DR DARLENE POWELL GARLINGTON PSYCHOLOGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:DR DARLENE POWELL GARLINGTON PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL GARLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-604-5888
Mailing Address - Street 1:2280 GRAND AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3110
Mailing Address - Country:US
Mailing Address - Phone:516-679-0457
Mailing Address - Fax:203-841-1140
Practice Address - Street 1:2280 GRAND AVE STE 304
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3110
Practice Address - Country:US
Practice Address - Phone:516-679-0457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-01
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04075747Medicaid