| Ross Lynn Tabisel, Lcsw, Ph.d, Pc. | |
|
54 Sunnyside Blvd Ste A Plainview NY 11803-1517 | |
| (516) 576-1118 | |
| (516) 576-8876 |
| Full Name | Ross Lynn Tabisel, Lcsw, Ph.d, Pc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 54 Sunnyside Blvd Ste A, Plainview, New York |
| Authorized Official Name and Position | Ross Lynn Tabisel (OWNER/PRESIDENT) |
| Authorized Official Contact | 5165761118 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ross Lynn Tabisel, Lcsw, Ph.d, Pc. 54 Sunnyside Blvd Ste A Plainview NY 11803-1517 Ph: (516) 576-1118 | Ross Lynn Tabisel, Lcsw, Ph.d, Pc. 54 Sunnyside Blvd Ste A Plainview NY 11803-1517 Ph: (516) 576-1118 |
| NPI Number | 1790088854 |
|---|---|
| Provider Enumeration Date | 12/13/2010 |
| Last Update Date | 12/13/2010 |
| Medicare PECOS PAC ID | 1759579444 |
|---|---|
| Medicare Enrollment ID | O20101222000215 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790088854 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | R013521-1 (New York) | Primary |
| Provider Name | Ross Lynn Tabisel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336237270 PECOS PAC ID: 2264620954 Enrollment ID: I20101222000269 |
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