Provider Demographics
NPI:1598435075
Name:EMPOWERED LIFE MENTAL HEALTH COUNSELING PC
Entity type:Organization
Organization Name:EMPOWERED LIFE MENTAL HEALTH COUNSELING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LURDES
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS-GALARZA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:631-355-8975
Mailing Address - Street 1:116 WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-1920
Mailing Address - Country:US
Mailing Address - Phone:631-355-8975
Mailing Address - Fax:
Practice Address - Street 1:340 VETERANS MEMORIAL HWY STE 2
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4300
Practice Address - Country:US
Practice Address - Phone:631-355-8975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1720339898Medicaid