Provider Demographics
NPI:1174546402
Name:FAMILY COUNSELING SERVICE
Entity type:Organization
Organization Name:FAMILY COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:DELAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-288-1954
Mailing Address - Street 1:PO BOX 1348
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11978
Mailing Address - Country:US
Mailing Address - Phone:631-288-1954
Mailing Address - Fax:631-288-1955
Practice Address - Street 1:40 MAIN STREET
Practice Address - Street 2:BEINECKE BUILDING
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978
Practice Address - Country:US
Practice Address - Phone:631-288-1954
Practice Address - Fax:631-288-1955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9042100A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02056453Medicaid
NY02056453Medicaid