Provider Demographics
NPI:1811049604
Name:PSYCHOLOGICAL SERVICES ASSOCIATE PC
Entity type:Organization
Organization Name:PSYCHOLOGICAL SERVICES ASSOCIATE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ACCOMANDO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-599-2290
Mailing Address - Street 1:2563 EILEEN RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1308
Mailing Address - Country:US
Mailing Address - Phone:516-599-2290
Mailing Address - Fax:516-599-2815
Practice Address - Street 1:2563 EILEEN RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1308
Practice Address - Country:US
Practice Address - Phone:516-599-2290
Practice Address - Fax:516-599-2815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6185103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV8W051Medicare ID - Type Unspecified