| Emotional Health Counseling Consulting Lcsw Pc | |
|
105 E Main St Smithtown NY 11787-2858 | |
| (516) 316-5047 | |
| (631) 244-0757 |
| Full Name | Emotional Health Counseling Consulting Lcsw Pc |
|---|---|
| Speciality | Social Worker |
| Location | 105 E Main St, Smithtown, New York |
| Authorized Official Name and Position | Nicole Ashley Sullivan (OWNER & PRESIDENT) |
| Authorized Official Contact | 5163165047 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Emotional Health Counseling Consulting Lcsw Pc 105 E Main St Smithtown NY 11787-2858 Ph: (516) 316-5047 | Emotional Health Counseling Consulting Lcsw Pc 105 E Main St Smithtown NY 11787-2858 Ph: (516) 316-5047 |
| NPI Number | 1407582208 |
|---|---|
| Provider Enumeration Date | 07/26/2022 |
| Last Update Date | 07/26/2022 |
| Certification Date | 07/25/2022 |
| Medicare PECOS PAC ID | 7618340266 |
|---|---|
| Medicare Enrollment ID | O20230301000388 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407582208 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Nicole Ashley Sullivan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932625290 PECOS PAC ID: 0244603892 Enrollment ID: I20230301000460 |
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