Provider Demographics
NPI:1144523952
Name:COGNITIVE-BEHAVIORAL PSYCHOLOGY SERVICES OF LONG ISLAND PLLC
Entity type:Organization
Organization Name:COGNITIVE-BEHAVIORAL PSYCHOLOGY SERVICES OF LONG ISLAND PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:EBERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-558-7490
Mailing Address - Street 1:71 W MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OYSTER BAY
Mailing Address - State:NY
Mailing Address - Zip Code:11771-2258
Mailing Address - Country:US
Mailing Address - Phone:516-558-7490
Mailing Address - Fax:877-205-6740
Practice Address - Street 1:71 W MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:OYSTER BAY
Practice Address - State:NY
Practice Address - Zip Code:11771-2258
Practice Address - Country:US
Practice Address - Phone:516-558-7490
Practice Address - Fax:877-205-6740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009143-1103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWXZRW1Medicare PIN