| Crescent Light Counseling, Lcsw, Pllc | |
|
646 Main St Ste 102 Port Jefferson NY 11777-2230 | |
| (631) 772-9395 | |
| Not Available |
| Full Name | Crescent Light Counseling, Lcsw, Pllc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 646 Main St Ste 102, Port Jefferson, New York |
| Authorized Official Name and Position | Taylor Schultz (MANAGER/OWNER) |
| Authorized Official Contact | 6316173696 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Crescent Light Counseling, Lcsw, Pllc 646 Main St Ste 102 Port Jefferson NY 11777-2230 Ph: (631) 772-9395 | Crescent Light Counseling, Lcsw, Pllc 646 Main St Ste 102 Port Jefferson NY 11777-2230 Ph: (631) 772-9395 |
| NPI Number | 1275280620 |
|---|---|
| Provider Enumeration Date | 03/06/2022 |
| Last Update Date | 03/28/2022 |
| Certification Date | 03/28/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275280620 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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