Provider Demographics
NPI:1750673992
Name:COUNSELING & PSYCHOLOGICAL SERVICES FOR THE INDIVIDUAL, FAMILY, GROUP,
Entity Type:Organization
Organization Name:COUNSELING & PSYCHOLOGICAL SERVICES FOR THE INDIVIDUAL, FAMILY, GROUP,
Other - Org Name:THE COUNSELING AND PSYCHOTHERAPY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:RABINOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-868-8401
Mailing Address - Street 1:124 MERRICK AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3434
Mailing Address - Country:US
Mailing Address - Phone:516-868-8401
Mailing Address - Fax:516-239-0443
Practice Address - Street 1:124 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3434
Practice Address - Country:US
Practice Address - Phone:516-868-8401
Practice Address - Fax:516-239-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009010103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV47211Medicare PIN