Individual
DR. GEORGE JAMES BOUKLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D
Contact information
Practice address
69A GNARLED HOLLOW RD, EAST SETAUKET, NY 11733-2026
(631) 751-0092
(631) 689-6201
Mailing address
69A GNARLED HOLLOW RD, EAST SETAUKET, NY 11733-2026
(631) 751-0092
(631) 689-6201
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
011248
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01338949
—
NY
Enumeration date
02/05/2007
Last updated
07/08/2007
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