| First Light Psychological Services, P.l.l.c. | |
|
1111 Broadhollow Rd Suite 204 Farmingdale NY 11735-4820 | |
| (631) 414-7181 | |
| (631) 414-7178 |
| Full Name | First Light Psychological Services, P.l.l.c. |
|---|---|
| Speciality | Psychologist |
| Location | 1111 Broadhollow Rd, Farmingdale, New York |
| Authorized Official Name and Position | Theresa Irene Desantis (PRESIDENT) |
| Authorized Official Contact | 6314147181 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| First Light Psychological Services, P.l.l.c. 32 Sally Ln Plainview NY 11803-1434 Ph: (516) 637-0689 | First Light Psychological Services, P.l.l.c. 1111 Broadhollow Rd Suite 204 Farmingdale NY 11735-4820 Ph: (631) 414-7181 |
| NPI Number | 1922166628 |
|---|---|
| Provider Enumeration Date | 12/05/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 9032450531 |
|---|---|
| Medicare Enrollment ID | O20190410001889 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922166628 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 68-60276 (New York) | Primary |
| Provider Name | Theresa Irene Desantis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1194883884 PECOS PAC ID: 0941541445 Enrollment ID: I20190410001986 |
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