Provider Demographics
NPI:1669526562
Name:PENINSULA COUNSELING CENTER
Entity type:Organization
Organization Name:PENINSULA COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:516-239-1945
Mailing Address - Street 1:124 FRANKLIN PL
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1203
Mailing Address - Country:US
Mailing Address - Phone:516-569-6600
Mailing Address - Fax:516-374-2261
Practice Address - Street 1:124 FRANKLIN PL
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1203
Practice Address - Country:US
Practice Address - Phone:516-569-6600
Practice Address - Fax:516-374-2261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17384711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty