Provider Demographics
NPI:1356977177
Name:SUFFOLK FAMILY THERAPY LCSW PC
Entity type:Organization
Organization Name:SUFFOLK FAMILY THERAPY LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:VOLLMOELLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-503-1539
Mailing Address - Street 1:4109 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-4600
Mailing Address - Country:US
Mailing Address - Phone:531-503-1539
Mailing Address - Fax:
Practice Address - Street 1:606 JOHNSON AVE STE 34
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-2689
Practice Address - Country:US
Practice Address - Phone:631-503-1539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-13
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty