NPIMap

Organization Active NPI

Town of Islip

  • Addiction (Substance Use Disorder) Counselor
  • Brentwood, NY
National Provider Identifier
1215029004
Registry record updated Sep 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
080611082 Issued in NY
Legal business name
TOWN OF ISLIP
Practice address
452 Suffolk Ave
Brentwood, NY 11717
Phone
(631) 436-6065
Fax
(631) 436-6068
NPI assigned
Sep 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Delores Bocklet
Title
Director
Phone
(631) 224-5330

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YA0400X 080611082 NY Primary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YA0400X 091111083 NY

Addresses

Primary practice location

452 Suffolk Ave
Brentwood, NY 11717

Mailing address

452 Suffolk Ave
Brentwood, NY 11717
Phone (631) 436-6065

Other identifiers 1

IdentifierTypeStateIssuer
01316081MedicaidNY

Other names 1

  • Acceso Other name

National Provider Directory

National Provider Directory
Tax ID family
Acceso3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

452 Suffolk Ave
Brentwood, NY 11717
Phone (631) 436-6065

Practitioners & affiliated clinicians

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 27

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222128000000",
    "number": "1215029004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "452 SUFFOLK AVE",
            "city": "BRENTWOOD",
            "state": "NY",
            "postal_code": "11717",
            "telephone_number": "631-436-6065",
            "fax_number": "631-436-6068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "452 SUFFOLK AVE",
            "city": "BRENTWOOD",
            "state": "NY",
            "postal_code": "11717",
            "telephone_number": "631-436-6065",
            "fax_number": "631-436-6068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOWN OF ISLIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-29",
        "last_updated": "2008-09-23",
        "status": "A",
        "authorized_official_last_name": "BOCKLET",
        "authorized_official_first_name": "DELORES",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "631-224-5330"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "080611082",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "091111083",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01316081",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Acceso",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Brentwood, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.