Provider Demographics
NPI:1245488527
Name:CHILD & ADOLESCENT PSYCHOLOGICAL SERVICE & WELLNESS, P.C.
Entity type:Organization
Organization Name:CHILD & ADOLESCENT PSYCHOLOGICAL SERVICE & WELLNESS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:NATALUCCI-HALL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:631-239-5956
Mailing Address - Street 1:496 SMITHTOWN BYP
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5005
Mailing Address - Country:US
Mailing Address - Phone:631-239-5956
Mailing Address - Fax:
Practice Address - Street 1:496 SMITHTOWN BYP
Practice Address - Street 2:SUITE 304
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5005
Practice Address - Country:US
Practice Address - Phone:631-239-5956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012586-01103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty