Shoreham Psychotherapy Services Lcsw PLLC
Social Worker, Clinical in Shoreham, NY. Organization (NPI-2).
NPI number1669860573
StatusActive
Last updated in NPPESDec 30, 2014
Details
- NPI
- 1669860573
- Entity type
- Organization (NPI-2)
- Legal business name
- Shoreham Psychotherapy Services Lcsw PLLC
- Organization subpart
- No
- Enumeration date
- Dec 30, 2014
- Last updated
- Dec 30, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | R022772 | NY | Yes |
| 1041C0700X | Social Worker, Clinical | 117957 | MA |
Practice location
45 Route 25aSuite A2
Shoreham, NY 11786-1389
Phone 631-821-5056 · Fax 631-821-5056
Mailing address
45 Route 25aSuite A2
Shoreham, NY 11786-1389
Phone 631-821-5056 · Fax 631-821-5056
Authorized official
Mary Lee Hasbrouck
President
6318215056
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