Provider Demographics
NPI:1942446802
Name:CLINICAL THERAPEUTIC SERVICES OF LONG ISLAND,LCSW,PLLC
Entity Type:Organization
Organization Name:CLINICAL THERAPEUTIC SERVICES OF LONG ISLAND,LCSW,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIB
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:516-333-8523
Mailing Address - Street 1:3051 HEWLETT AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-5314
Mailing Address - Country:US
Mailing Address - Phone:516-333-8523
Mailing Address - Fax:516-223-1712
Practice Address - Street 1:3051 HEWLETT AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-5314
Practice Address - Country:US
Practice Address - Phone:516-333-8523
Practice Address - Fax:516-223-1712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-25
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069998-R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPTANA100001306Medicare UPIN