Provider Demographics
NPI:1710494760
Name:FOCUS FEEDBACK PSYCHOLOGICAL AND OCCUPATIONAL THERAPY SERVICES, PLLC
Entity Type:Organization
Organization Name:FOCUS FEEDBACK PSYCHOLOGICAL AND OCCUPATIONAL THERAPY SERVICES, PLLC
Other - Org Name:FOCUS FEEDBACK, PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:MICHAELIDES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:631-240-3030
Mailing Address - Street 1:358 VETERANS HWY STE 12
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4326
Mailing Address - Country:US
Mailing Address - Phone:631-240-3030
Mailing Address - Fax:
Practice Address - Street 1:358 VETERANS MEMORIAL HWY STE 12
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725
Practice Address - Country:US
Practice Address - Phone:631-240-3030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-29
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020318103T00000X
NY014831225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty