Provider Demographics
NPI:1962002675
Name:CHERYL R. BUSCAGLIA, LICENSED MENTAL HEALTH COUNSELOR, PLLC
Entity Type:Organization
Organization Name:CHERYL R. BUSCAGLIA, LICENSED MENTAL HEALTH COUNSELOR, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:R
Authorized Official - Last Name:BUSCAGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:516-308-6610
Mailing Address - Street 1:7 FAWN LN
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-3814
Mailing Address - Country:US
Mailing Address - Phone:516-308-6610
Mailing Address - Fax:
Practice Address - Street 1:80 ORVILLE DR STE 100
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-2505
Practice Address - Country:US
Practice Address - Phone:516-308-6610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty