Provider Demographics
NPI:1548876790
Name:EXPRESSIVE CONNECTIONS MENTAL HEALTH COUNSELING, PLLC
Entity type:Organization
Organization Name:EXPRESSIVE CONNECTIONS MENTAL HEALTH COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIBERNARDO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, BCB
Authorized Official - Phone:516-650-4164
Mailing Address - Street 1:63 LOUDEN AVE
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2736
Mailing Address - Country:US
Mailing Address - Phone:515-650-4164
Mailing Address - Fax:
Practice Address - Street 1:211 BROADWAY
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3290
Practice Address - Country:US
Practice Address - Phone:516-619-6477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-22
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health