Provider Demographics
NPI:1801493366
Name:CHILD AND FAMILY PSYCHOLOGICAL SERVICES PC
Entity type:Organization
Organization Name:CHILD AND FAMILY PSYCHOLOGICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOHENY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:631-265-9850
Mailing Address - Street 1:521 ROUTE 111 STE 202
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-4358
Mailing Address - Country:US
Mailing Address - Phone:631-265-9850
Mailing Address - Fax:631-265-9852
Practice Address - Street 1:521 ROUTE 111 STE 202
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4358
Practice Address - Country:US
Practice Address - Phone:631-265-9850
Practice Address - Fax:631-265-9852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-07
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)