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Organization
PRIVATE PRACTICE PSYCHIATRY SERVICES LLC
Active
Organization
PRIVATE PRACTICE PSYCHIATRY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBORAH PETRY LCSW-R (COUNSELOR)
(631) 392-4357
Entity
Organization
Contact information
Practice address
67 E MAIN ST, RIVERHEAD, NY 11901-2422
(631) 392-4357
(631) 392-4358
Mailing address
67 E MAIN ST, RIVERHEAD, NY 11901-2422
(631) 392-4358
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1497856108
COMMERICAL
NY
Enumeration date
09/09/2019
Last updated
09/09/2019
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