Provider Demographics
NPI:1922416676
Name:PASSAGES WELLNESS & COUNSELING FOR WOMEN
Entity Type:Organization
Organization Name:PASSAGES WELLNESS & COUNSELING FOR WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-941-1200
Mailing Address - Street 1:348 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3800
Mailing Address - Country:US
Mailing Address - Phone:631-941-1200
Mailing Address - Fax:631-941-1201
Practice Address - Street 1:348 MAIN ST
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3800
Practice Address - Country:US
Practice Address - Phone:631-941-1200
Practice Address - Fax:631-941-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0711061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty