| Ican Innovative Counseling And Assessment Of Nassau | |
|
191 Bradley Ave Staten Island NY 10314-5166 | |
| (516) 558-3010 | |
| (516) 558-3011 |
| Full Name | Ican Innovative Counseling And Assessment Of Nassau |
|---|---|
| Speciality | Psychologist |
| Location | 191 Bradley Ave, Staten Island, New York |
| Authorized Official Name and Position | Elie Cohen (OWNER) |
| Authorized Official Contact | 5165583010 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ican Innovative Counseling And Assessment Of Nassau 70 E Sunrise Highway Suite 500 #6409 Valley Stream NY 11581 Ph: (516) 558-3010 | Ican Innovative Counseling And Assessment Of Nassau 191 Bradley Ave Staten Island NY 10314-5166 Ph: (516) 558-3010 |
| NPI Number | 1053768424 |
|---|---|
| Provider Enumeration Date | 05/16/2016 |
| Last Update Date | 11/04/2022 |
| Certification Date | 11/04/2022 |
| Medicare PECOS PAC ID | 2567702343 |
|---|---|
| Medicare Enrollment ID | O20190313002133 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053768424 | NPI | - | NPPES |
| 03965299 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 020858 (New York) | Primary |
| Provider Name | Elie N Cohen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1457751059 PECOS PAC ID: 7911128954 Enrollment ID: I20141016001394 |
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