Provider Demographics
NPI:1790166254
Name:COUNSELING ASSOCIATES OF LONG ISLAND,INC.
Entity Type:Organization
Organization Name:COUNSELING ASSOCIATES OF LONG ISLAND,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WINSOME
Authorized Official - Middle Name:SHIRLEY
Authorized Official - Last Name:BROWN-COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:516-797-4851
Mailing Address - Street 1:727 N BROADWAY STE A2
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2348
Mailing Address - Country:US
Mailing Address - Phone:516-797-4851
Mailing Address - Fax:
Practice Address - Street 1:727 N BROADWAY STE A2
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2348
Practice Address - Country:US
Practice Address - Phone:516-797-4851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-10
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR04044511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty