Cerulean Willow Mental Health Counseling PLLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

CERULEAN WILLOW MENTAL HEALTH COUNSELING PLLC

Practice address

1227 Main St Ste 302
Port Jefferson, NY 11777-2227

Phone

(631) 512-3079

NPI assigned

May 18, 2023

Organization subpart

No

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

Authorized official

Name

Daisy Denise Rodriguez, LMHCNPI 1922514926

Title

Founder

Phone

(631) 512-3079

Specialties & licenses 2

Addresses

Locations

Practitioners 1

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

• Daisy Denise Rodriguez

  • Mental Health Counselor
  • Port Jefferson, NY
  • NPI 1922514926
  NPD Authorized official

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

{
    "created_epoch": "1684368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698105600000",
    "number": "1427749688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 685",
            "city": "OYSTER BAY",
            "state": "NY",
            "postal_code": "117710685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1227 MAIN ST STE 302",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772227",
            "telephone_number": "631-512-3079"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "153 Main St",
            "address_purpose": "LOCATION",
            "city": "Cold Spring Harbor",
            "state": "NY",
            "postal_code": "117241437",
            "country_code": "US",
            "telephone_number": "631-512-3079",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CERULEAN WILLOW MENTAL HEALTH COUNSELING PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-18",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-24",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "DAISY",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "FOUNDER",
        "authorized_official_telephone_number": "631-512-3079",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gail Edith Cavanagh, LCSW
• James P. Cavanagh, MD
• Philip Joseph Celestino, C.PED.
• Alexandra Cella, LMSW
• Candice Cepeda
• Nancy Louise Cerullo, LCSW-R
• Sarah Marie Chacko, MD
• Sherly T Chamakala, N.P
• Bo Chao, M.D.
• Puja Charya, MD

• Mental Health Counselor in Port Jefferson, NY
• Providers in Port Jefferson, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2023; 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.