Organization
EASTERN SUFFOLK COUNSELING LCSW PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD GIRARD-DOMENA ED.D., LCSW-R (CLINICAL DORECTOR)
(631) 504-2102
Entity
Organization
Contact information
Practice address
551 N COUNTRY RD, SUITE 203, SAINT JAMES, NY 11780-1445
(631) 504-2102
Mailing address
PO BOX 150, CENTEREACH, NY 11720-0150
(631) 504-2102
(631) 686-5807
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
R078941-1
NY
Other
Enumeration date
06/14/2016
Last updated
06/14/2016
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