Behavioral Enhancement & Substance Abuse Medicine Treatment PLLC
Organization Active NPI Community/Behavioral Health Agency · Deer Park, NY
NPI 1346680071 · NPPES record last updated Dec 4, 2013
Key facts
- NPI
- 1346680071
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- License
- 140511797 (NY)
- Legal business name
- BEHAVIORAL ENHANCEMENT & SUBSTANCE ABUSE MEDICINE TREATMENT PLLC
- Practice address
- 770 Grand Blvd
Suite 17
Deer Park, NY 11729-5750 - Phone
- (631) 392-4357
- Fax
- (631) 392-4358
- NPI assigned
- Jun 26, 2013
- Organization subpart
- No
Authorized official
- Name
- Ms. Deborah M. Petry, LCSW, CASAC
- Title
- Program Supervisor
- Phone
- (631) 392-4357
Practitioners 21
-
Tomrul Tuzel, M.D.
-
Deborah M Petry, LCSW-R
-
Tennille Burman, CASAC 2
-
Wilfredo Male Correa, CRPA
-
Kayla Edwards, BSW
-
Adam Friedman, CASAC-T
-
Tara M Gajewski, LMSW
-
Brianna Santella Morano, CASAC-T
-
Sarah Elizabeth Moyer, LMSW
-
Sarah Patterson-Hook, MSW, CASAC
-
Andrea L Spissinger, MHT, CASAC-2
-
Courtney Defeo, CASAC-T
-
Maria Cristina Liguori, LCSW
-
Claire Marie Lopardo, LCSW
-
Pallavi Shastri, CASAC
-
Daniella Trian, CASAC-T
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140512001557 | NY | Part B Supplier - Clinic/Group Practice | 9436382777 |
Receives reassigned benefits from 3 practitioners Practice locations: Deer Park, NY |
National Provider Directory
Locations
770 Grand Blvd
Ste 17
Deer Park, NY 11729
Phone (631) 392-4357
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | 140511797 | NY | Yes |
Addresses
Primary practice location
770 Grand Blvd
Suite 17
Deer Park, NY 11729-5750
Mailing address
770 Grand Blvd
Suite 17
Deer Park, NY 11729-5750
Phone (631) 392-4357
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 140511797 | Other | NY | OASAS |
Other providers in Deer Park, NY
- Gloria Sophia Bean
- Herlande Beaubrun
- Darlene Beaucicot
- Bee Bright Therapy, SLP, PLLC
- Bee Bright Therapy, SLP, PLLC
- Belle Vie NC
- Geraldine Abonete Beltran
- Jessica Benedetto
- Mayan Oneg Beroukhim
- Amanda Betzold
All providers in Deer Park, NY · Community/Behavioral Health Agency in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 4, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.