| Transformation Counseling Group | |
|
1 Rabro Dr Ste 10 Hauppauge NY 11788-4270 | |
| (631) 979-2775 | |
| Not Available |
| Full Name | Transformation Counseling Group |
|---|---|
| Speciality | Social Worker |
| Location | 1 Rabro Dr Ste 10, Hauppauge, New York |
| Authorized Official Name and Position | Kenneth Burns (OWNER) |
| Authorized Official Contact | 6312575900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Transformation Counseling Group 269 E Main St # F Smithtown NY 11787-2832 Ph: (631) 979-2775 | Transformation Counseling Group 1 Rabro Dr Ste 10 Hauppauge NY 11788-4270 Ph: (631) 979-2775 |
| NPI Number | 1902219512 |
|---|---|
| Provider Enumeration Date | 06/11/2014 |
| Last Update Date | 03/26/2020 |
| Certification Date | 03/26/2020 |
| Medicare PECOS PAC ID | 2264853597 |
|---|---|
| Medicare Enrollment ID | O20200522000303 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902219512 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 027434 (New York) | Primary |
| 1041C0700X | Social Worker - Clinical | 082535 (New York) | Secondary |
| Provider Name | Kenneth Burns |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508130089 PECOS PAC ID: 2567742224 Enrollment ID: I20161215000530 |
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