Provider Demographics
NPI:1326929902
Name:WELLNESS SERENITY PATHWAY NURSE PRACTITIONER IN PSYCHIATRY AND FAMILY HEALTH PLLC
Entity type:Organization
Organization Name:WELLNESS SERENITY PATHWAY NURSE PRACTITIONER IN PSYCHIATRY AND FAMILY HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP, FNP
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:516-272-0852
Mailing Address - Street 1:245 E MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-7532
Mailing Address - Country:US
Mailing Address - Phone:516-272-0852
Mailing Address - Fax:
Practice Address - Street 1:107 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2337
Practice Address - Country:US
Practice Address - Phone:516-272-0852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty