# BEHAVIORAL HEALTH NURSE PRACTITIONER PSYCHIATRIC SERVICES PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043606015
- **Authorized official:** MRS. DEBRA COANE (OFFICE MANAGER)
- **Authorized official phone:** (631) 681-4754

## Contact information

- **Practice address:** 28 ANNANDALE RD, COMMACK, NY 11725-1745
- **Practice address phone:** (631) 387-1496
- **Practice address fax:** (631) 893-4020
- **Mailing address:** 28 ANNANDALE RD, COMMACK, NY 11725-1745
- **Mailing address phone:** (631) 387-1496
- **Mailing address fax:** (631) 893-4020

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | F401327 | NY | Yes |

## Other

- **Enumeration date:** 04/07/2015
- **Last updated:** 05/20/2015