Organization
SOUTHEAST NASSAU GUIDANCE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JULIE OLIVA (CLINICAL ADMINISTRATOR)
(516) 221-3030
Entity
Organization
Contact information
Practice address
2146 JACKSON AVE, SEAFORD, NY 11783-2606
(516) 221-3030
(516) 221-1013
Mailing address
2146 JACKSON AVE, P.O. BOX 1037, SEAFORD, NY 11783-2606
(516) 221-3030
(516) 221-1013
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
091110995
NY
251S00000X
Community/Behavioral Health Agency
110510994
NY
251S00000X
Community/Behavioral Health Agency
Primary
6801100A
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083718779
—
NY
05
—
1124131461
—
NY
05
—
1295745214
—
NY
Enumeration date
10/20/2009
Last updated
10/20/2009
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