Provider Demographics
NPI:1720581879
Name:GOODING WELLNESS LCSW PC
Entity Type:Organization
Organization Name:GOODING WELLNESS LCSW PC
Other - Org Name:GOODING WELLNESS PSYCHOTHERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARNOTT
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:GOODING
Authorized Official - Suffix:III
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-351-2940
Mailing Address - Street 1:4 PENNINGTON DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-7112
Mailing Address - Country:US
Mailing Address - Phone:631-351-2950
Mailing Address - Fax:
Practice Address - Street 1:147 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLD SPRING HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11724-1425
Practice Address - Country:US
Practice Address - Phone:631-351-2950
Practice Address - Fax:631-824-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)