Provider Demographics
NPI:1942633029
Name:SMITHTOWN PSYCHOTHERAPY, LCSW PLLC
Entity Type:Organization
Organization Name:SMITHTOWN PSYCHOTHERAPY, LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELMA
Authorized Official - Middle Name:
Authorized Official - Last Name:PISANO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:631-724-0600
Mailing Address - Street 1:26 VIOLET RD
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-2335
Mailing Address - Country:US
Mailing Address - Phone:631-724-0600
Mailing Address - Fax:631-724-0606
Practice Address - Street 1:285 MIDDLE COUNTRY ROAD
Practice Address - Street 2:SUITE LL5
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787
Practice Address - Country:US
Practice Address - Phone:631-724-0600
Practice Address - Fax:631-724-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty