Provider Demographics
NPI:1790980753
Name:SOUTH BAY PSYCHOLOGICAL, P.C.
Entity Type:Organization
Organization Name:SOUTH BAY PSYCHOLOGICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SABARESE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:631-264-0058
Mailing Address - Street 1:217 MERRICK RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-3449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:217 MERRICK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-3449
Practice Address - Country:US
Practice Address - Phone:631-264-0058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty