| Active Change Psychological Services, Pllc | |
|
6800 Jericho Tpke Ste 120w Syosset NY 11791-4445 | |
| (516) 835-2048 | |
| Not Available |
| Full Name | Active Change Psychological Services, Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 6800 Jericho Tpke Ste 120w, Syosset, New York |
| Authorized Official Name and Position | Jay Evan Saul (MEMBER) |
| Authorized Official Contact | 5168352048 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Active Change Psychological Services, Pllc 6800 Jericho Tpke Ste 120w Syosset NY 11791-4445 Ph: (516) 835-2048 | Active Change Psychological Services, Pllc 6800 Jericho Tpke Ste 120w Syosset NY 11791-4445 Ph: (516) 835-2048 |
| NPI Number | 1053938837 |
|---|---|
| Provider Enumeration Date | 06/29/2020 |
| Last Update Date | 06/29/2020 |
| Certification Date | 06/29/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053938837 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
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