Provider Demographics
NPI:1295062693
Name:KONTOS PSYCHOTHERAPY LCSW PC
Entity type:Organization
Organization Name:KONTOS PSYCHOTHERAPY LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KALLIRROY
Authorized Official - Middle Name:
Authorized Official - Last Name:KONTOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R, CASAC, BCD
Authorized Official - Phone:631-592-2179
Mailing Address - Street 1:PO BOX 872
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-0872
Mailing Address - Country:US
Mailing Address - Phone:631-592-2179
Mailing Address - Fax:631-592-8060
Practice Address - Street 1:183 S WELLWOOD AVE
Practice Address - Street 2:STE. C
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-4935
Practice Address - Country:US
Practice Address - Phone:631-592-2179
Practice Address - Fax:631-592-8060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100086695Medicare PIN