Provider Demographics
NPI:1295745214
Name:SOUTHEAST NASSAU GUIDANCE CENTER INC.
Entity type:Organization
Organization Name:SOUTHEAST NASSAU GUIDANCE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-221-3030
Mailing Address - Street 1:2146 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-2606
Mailing Address - Country:US
Mailing Address - Phone:516-221-3030
Mailing Address - Fax:516-221-1013
Practice Address - Street 1:2146 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-2606
Practice Address - Country:US
Practice Address - Phone:516-221-3030
Practice Address - Fax:516-221-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW02651Medicare ID - Type Unspecified