Provider Demographics
NPI:1346591013
Name:BEHAVIORAL INTERVENTION PSYCHOLOGICAL SERVICES PC
Entity type:Organization
Organization Name:BEHAVIORAL INTERVENTION PSYCHOLOGICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMOUN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LBA
Authorized Official - Phone:516-331-1587
Mailing Address - Street 1:22 W COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-2411
Mailing Address - Country:US
Mailing Address - Phone:516-331-1587
Mailing Address - Fax:516-216-4231
Practice Address - Street 1:22 W COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-2411
Practice Address - Country:US
Practice Address - Phone:516-331-1587
Practice Address - Fax:516-216-4231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health