| Supportive Psychological Services Of Long Island, P.c. | |
|
6500 Jericho Tpke Commack NY 11725-2909 | |
| (631) 252-1221 | |
| Not Available |
| Full Name | Supportive Psychological Services Of Long Island, P.c. |
|---|---|
| Speciality | Psychologist |
| Location | 6500 Jericho Tpke, Commack, New York |
| Authorized Official Name and Position | Linda Ganzenmuller (PRESIDENT) |
| Authorized Official Contact | 6312521221 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Supportive Psychological Services Of Long Island, P.c. Po Box 1226 Commack NY 11725-0900 Ph: (631) 252-1221 | Supportive Psychological Services Of Long Island, P.c. 6500 Jericho Tpke Commack NY 11725-2909 Ph: (631) 252-1221 |
| NPI Number | 1285169193 |
|---|---|
| Provider Enumeration Date | 04/28/2017 |
| Last Update Date | 04/28/2017 |
| Medicare PECOS PAC ID | 7618249152 |
|---|---|
| Medicare Enrollment ID | O20170818000962 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285169193 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Linda A Ganzenmuller |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1720144900 PECOS PAC ID: 5395927396 Enrollment ID: I20110312000041 |
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