Provider Demographics
NPI:1790088854
Name:ROSS LYNN TABISEL, LCSW, PH.D, PC.
Entity Type:Organization
Organization Name:ROSS LYNN TABISEL, LCSW, PH.D, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:TABISEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, PHD
Authorized Official - Phone:516-576-1118
Mailing Address - Street 1:54 SUNNYSIDE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1517
Mailing Address - Country:US
Mailing Address - Phone:516-576-1118
Mailing Address - Fax:516-576-8876
Practice Address - Street 1:54 SUNNYSIDE BLVD STE A
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1517
Practice Address - Country:US
Practice Address - Phone:516-576-1118
Practice Address - Fax:516-576-8876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR013521-1261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health