| Vitality Counseling Lcsw Pc | |
|
11 Thayer Pl West Islip NY 11795-4331 | |
| (631) 834-8647 | |
| Not Available |
| Full Name | Vitality Counseling Lcsw Pc |
|---|---|
| Speciality | Social Worker |
| Location | 11 Thayer Pl, West Islip, New York |
| Authorized Official Name and Position | Jessica Grace Thalhamer (OWNER) |
| Authorized Official Contact | 6318348647 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitality Counseling Lcsw Pc Po Box 188 West Islip NY 11795-0188 Ph: (631) 834-8647 | Vitality Counseling Lcsw Pc 11 Thayer Pl West Islip NY 11795-4331 Ph: (631) 834-8647 |
| NPI Number | 1790519122 |
|---|---|
| Provider Enumeration Date | 08/28/2024 |
| Last Update Date | 08/28/2024 |
| Certification Date | 08/28/2024 |
| Medicare PECOS PAC ID | 6406388347 |
|---|---|
| Medicare Enrollment ID | O20241016001779 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790519122 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jessica Thalhamer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639647837 PECOS PAC ID: 4082056361 Enrollment ID: I20240531003222 |
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