Organization
BEHAVIORAL ENHANCEMENT & SUBSTANCE ABUSE MEDICINE TREATMENT PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBORAH M. PETRY LCSW, CASAC (PROGRAM SUPERVISOR)
(631) 392-4357
Entity
Organization
Contact information
Practice address
770 GRAND BLVD, SUITE 17, DEER PARK, NY 11729-5750
(631) 392-4357
(631) 392-4358
Mailing address
770 GRAND BLVD, SUITE 17, DEER PARK, NY 11729-5750
(631) 392-4357
(631) 392-4358
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
140511797
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140511797
OASAS
NY
Enumeration date
06/26/2013
Last updated
12/04/2013
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