Provider Demographics
NPI:1356601330
Name:LONG ISLAND BIOFEEDBACK AND HYPNOSIS INC.
Entity type:Organization
Organization Name:LONG ISLAND BIOFEEDBACK AND HYPNOSIS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:516-508-6900
Mailing Address - Street 1:10 NORMAN CT
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-1529
Mailing Address - Country:US
Mailing Address - Phone:516-508-6900
Mailing Address - Fax:516-352-2596
Practice Address - Street 1:1575 HILLSIDE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2521
Practice Address - Country:US
Practice Address - Phone:516-508-6900
Practice Address - Fax:516-352-2596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000201-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty