Organization
TOWN OF ISLIP
Active
Other names
Acceso
Organization subpart
No
Provider details
NPI number
Authorized official
DELORES BOCKLET (DIRECTOR)
(631) 224-5330
Entity
Organization
Contact information
Practice address
452 SUFFOLK AVE, BRENTWOOD, NY 11717
(631) 436-6065
(631) 436-6068
Mailing address
452 SUFFOLK AVE, BRENTWOOD, NY 11717
(631) 436-6065
(631) 436-6068
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
080611082
NY
101YA0400X
Addiction (Substance Use Disorder) Counselor
091111083
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01316081
—
NY
Enumeration date
09/29/2006
Last updated
09/23/2008
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