| Cerulean Willow Mental Health Counseling Pllc | |
|
1227 Main St Ste 302 Port Jefferson NY 11777-2227 | |
| (631) 512-3079 | |
| Not Available |
| Full Name | Cerulean Willow Mental Health Counseling Pllc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1227 Main St Ste 302, Port Jefferson, New York |
| Authorized Official Name and Position | Daisy Denise Rodriguez (FOUNDER) |
| Authorized Official Contact | 6315123079 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cerulean Willow Mental Health Counseling Pllc Po Box 685 Oyster Bay NY 11771-0685 Ph: () - | Cerulean Willow Mental Health Counseling Pllc 1227 Main St Ste 302 Port Jefferson NY 11777-2227 Ph: (631) 512-3079 |
| NPI Number | 1427749688 |
|---|---|
| Provider Enumeration Date | 05/18/2023 |
| Last Update Date | 10/24/2023 |
| Certification Date | 10/24/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427749688 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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