| Shoreham Psychotherapy Services Lcsw Pllc | |
|
45 Route 25a Suite A2 Shoreham NY 11786-1389 | |
| (631) 821-5056 | |
| (631) 821-5056 |
| Full Name | Shoreham Psychotherapy Services Lcsw Pllc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 45 Route 25a, Shoreham, New York |
| Authorized Official Name and Position | Mary Lee Hasbrouck (PRESIDENT) |
| Authorized Official Contact | 6318215056 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shoreham Psychotherapy Services Lcsw Pllc 45 Route 25a Suite A2 Shoreham NY 11786-1389 Ph: (631) 821-5056 | Shoreham Psychotherapy Services Lcsw Pllc 45 Route 25a Suite A2 Shoreham NY 11786-1389 Ph: (631) 821-5056 |
| NPI Number | 1669860573 |
|---|---|
| Provider Enumeration Date | 12/30/2014 |
| Last Update Date | 12/30/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669860573 | NPI | - | NPPES |
| 01475396 | Medicaid | NY | |
| 10498656 | Other | NY | CAQH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | R022772 (New York) | Primary |
| 1041C0700X | Social Worker - Clinical | 117957 (Massachusetts) | Secondary |
Diane Gavares Licensed Clinical Social Worker P.c. Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 3 Middle Cross, Shoreham, NY 11786 Phone: 631-849-2341 |