Provider Demographics
NPI:1922567866
Name:KSD FAMILY SOLUTIONS, LLC
Entity Type:Organization
Organization Name:KSD FAMILY SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:SULLIVAN
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-375-3645
Mailing Address - Street 1:2194 WILLOUGHBY AVE
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-4129
Mailing Address - Country:US
Mailing Address - Phone:516-375-3645
Mailing Address - Fax:
Practice Address - Street 1:2174 HEWLETT AVE STE 107A
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3612
Practice Address - Country:US
Practice Address - Phone:516-375-3645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)