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132 Jefferson Ave Mineola NY 11501-2712 | |
| (516) 741-0994 | |
| (516) 742-5396 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 132 Jefferson Ave, Mineola, New York |
| Authorized Official Name and Position | Molly W. Blancke (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5167410994 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
132 Jefferson Ave Mineola NY 11501-2712 Ph: () - | 132 Jefferson Ave Mineola NY 11501-2712 Ph: (516) 741-0994 |
| NPI Number | 1083759146 |
|---|---|
| Provider Enumeration Date | 02/20/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 0749608032 |
|---|---|
| Medicare Enrollment ID | O20200918000866 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083759146 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Danita Omeir-wright |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023307006 PECOS PAC ID: 8426035205 Enrollment ID: I20140203001303 |
| Provider Name | Cynthia Y Terrell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528212263 PECOS PAC ID: 8921435249 Enrollment ID: I20200227000163 |
| Provider Name | Elizabeth Camp Geiling |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1871778274 PECOS PAC ID: 9830637073 Enrollment ID: I20240819002643 |
| Provider Name | Jennifer Siemann |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962232777 PECOS PAC ID: 5294273249 Enrollment ID: I20240821002444 |
| Provider Name | Danielle Eisenberg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538645205 PECOS PAC ID: 6406397652 Enrollment ID: I20240916002191 |
| Provider Name | Janet Ann Siry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669619433 PECOS PAC ID: 2668913344 Enrollment ID: I20240920003079 |
| Provider Name | Ronald Wayne Lehenbauer |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1841328945 PECOS PAC ID: 1456883487 Enrollment ID: I20241016000994 |
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