Provider Demographics
NPI:1841577004
Name:CLOSSON, MARK S (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:CLOSSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 FRANKLIN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5760
Mailing Address - Country:US
Mailing Address - Phone:516-669-0135
Mailing Address - Fax:631-754-1642
Practice Address - Street 1:601 FRANKLIN AVE STE 200
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5760
Practice Address - Country:US
Practice Address - Phone:516-669-0135
Practice Address - Fax:631-754-1642
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019356103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical