Individual
DR. LINO FACCINI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
241 CEDAR AVE, ISLIP, NY 11751-4610
(631) 819-1192
Mailing address
241 CEDAR AVE, ISLIP, NY 11751-4610
(631) 819-1192
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
011517
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011517
NYS LICENSE
NY
Enumeration date
03/31/2020
Last updated
03/31/2020
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