| Psychotherapy At Home, Lcsw, Pllc | |
|
326 Sea Cliff St Islip Terrace NY 11752-1109 | |
| (516) 302-5645 | |
| Not Available |
| Full Name | Psychotherapy At Home, Lcsw, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 326 Sea Cliff St, Islip Terrace, New York |
| Authorized Official Name and Position | Dana J Legrande (OWNER) |
| Authorized Official Contact | 5163025645 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychotherapy At Home, Lcsw, Pllc 700 Fulton St Apt M3 Farmingdale NY 11735-3447 Ph: (516) 302-5645 | Psychotherapy At Home, Lcsw, Pllc 326 Sea Cliff St Islip Terrace NY 11752-1109 Ph: (516) 302-5645 |
| NPI Number | 1255898342 |
|---|---|
| Provider Enumeration Date | 02/25/2019 |
| Last Update Date | 02/07/2023 |
| Certification Date | 02/07/2023 |
| Medicare PECOS PAC ID | 5092175703 |
|---|---|
| Medicare Enrollment ID | O20230713000242 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255898342 | NPI | - | NPPES |
| 03461263 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Dana Legrande |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326364084 PECOS PAC ID: 5991932642 Enrollment ID: I20131230000878 |
| Provider Name | Mary Robyn Hall |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629635537 PECOS PAC ID: 5193268761 Enrollment ID: I20240624003984 |