| New Enlightenment Behavioral Services Inc | |
|
551 N Country Rd Ste 203 Saint James NY 11780-1445 | |
| (631) 504-2102 | |
| Not Available |
| Full Name | New Enlightenment Behavioral Services Inc |
|---|---|
| Speciality | Social Worker |
| Location | 551 N Country Rd Ste 203, Saint James, New York |
| Authorized Official Name and Position | Richard Girard-domena (OWNER) |
| Authorized Official Contact | 6315042102 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| New Enlightenment Behavioral Services Inc 47 Round Hill Rd Apt 13 Northampton MA 01060-2284 Ph: (631) 504-2102 | New Enlightenment Behavioral Services Inc 551 N Country Rd Ste 203 Saint James NY 11780-1445 Ph: (631) 504-2102 |
| NPI Number | 1942061403 |
|---|---|
| Provider Enumeration Date | 01/22/2024 |
| Last Update Date | 01/22/2024 |
| Certification Date | 01/21/2024 |
| Medicare PECOS PAC ID | 7618313685 |
|---|---|
| Medicare Enrollment ID | O20240313000201 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942061403 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Richard Girard-domena |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326369257 PECOS PAC ID: 8022142058 Enrollment ID: I20120215000180 |
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