Individual
MR. BOBBY L STALEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.C.S.W.
Contact information
Practice address
19605 FOOTHILL AVE, HOLLIS, NY 11423-1413
(917) 680-0082
Mailing address
19825 DUNTON AVE, 2ND FL, HOLLIS, NY 11423-1409
(917) 680-0082
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
23692
NY
1041C0700X
Clinical Social Worker
Primary
083565
NY
Other
Enumeration date
03/22/2013
Last updated
02/07/2019
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