Provider Demographics
NPI:1366894750
Name:LONG ISLAND COUNSELING LCSW PC
Entity type:Organization
Organization Name:LONG ISLAND COUNSELING LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:PELLETTIERI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:516-680-5967
Mailing Address - Street 1:2255 CENTRE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-3499
Mailing Address - Country:US
Mailing Address - Phone:516-882-4544
Mailing Address - Fax:631-206-9299
Practice Address - Street 1:2545 HEMPSTEAD TPKE STE 105
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2147
Practice Address - Country:US
Practice Address - Phone:516-882-4544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-08
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056086R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty