Provider Demographics
NPI:1396571667
Name:FIRE ISLAND PINES PSYCHOTHERAPY LCSW PLLC
Entity type:Organization
Organization Name:FIRE ISLAND PINES PSYCHOTHERAPY LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:SKREZYNA-WUNSCH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-201-9692
Mailing Address - Street 1:293 SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-2041
Mailing Address - Country:US
Mailing Address - Phone:631-201-9692
Mailing Address - Fax:631-203-9599
Practice Address - Street 1:606 JOHNSON AVE STE 9
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-2687
Practice Address - Country:US
Practice Address - Phone:631-201-9692
Practice Address - Fax:631-203-9599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty