Provider Demographics
NPI:1851896997
Name:BIOFEEDBACK, MENTAL HEALTH COUNSELING AND CREATIVE ARTS THERAPY, PLLC
Entity Type:Organization
Organization Name:BIOFEEDBACK, MENTAL HEALTH COUNSELING AND CREATIVE ARTS THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTELIS
Authorized Official - Suffix:
Authorized Official - Credentials:MPS, LMHC
Authorized Official - Phone:516-825-6567
Mailing Address - Street 1:211 BROADWAY STE 207
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3290
Mailing Address - Country:US
Mailing Address - Phone:516-825-6567
Mailing Address - Fax:516-825-6567
Practice Address - Street 1:211 BROADWAY STE 207
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3290
Practice Address - Country:US
Practice Address - Phone:516-825-6567
Practice Address - Fax:516-825-6567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1699860940OtherNATIONAL PROVIDER IDENTIFIER