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Organization
SHOREHAM PSYCHOTHERAPY SERVICES LCSW PLLC
Active
Organization
SHOREHAM PSYCHOTHERAPY SERVICES LCSW PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY LEE HASBROUCK LCSW (PRESIDENT)
(631) 821-5056
Entity
Organization
Contact information
Practice address
45 ROUTE 25A, SUITE A2, SHOREHAM, NY 11786-1389
(631) 821-5056
(631) 821-5056
Mailing address
45 ROUTE 25A, SUITE A2, SHOREHAM, NY 11786-1389
(631) 821-5056
(631) 821-5056
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
117957
MA
1041C0700X
Clinical Social Worker
Primary
R022772
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01475396
—
NY
01
—
10498656
CAQH
NY
Enumeration date
12/30/2014
Last updated
12/30/2014
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