Provider Demographics
NPI:1922166628
Name:FIRST LIGHT PSYCHOLOGICAL SERVICES, P.L.L.C.
Entity Type:Organization
Organization Name:FIRST LIGHT PSYCHOLOGICAL SERVICES, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:DESANTIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:631-414-7181
Mailing Address - Street 1:32 SALLY LN
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1434
Mailing Address - Country:US
Mailing Address - Phone:516-637-0689
Mailing Address - Fax:631-414-7178
Practice Address - Street 1:1111 BROADHOLLOW RD
Practice Address - Street 2:SUITE 204
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-4820
Practice Address - Country:US
Practice Address - Phone:631-414-7181
Practice Address - Fax:631-414-7178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68-60276103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty