Provider Demographics
NPI:1831260082
Name:COMMUNITY COUNSELING SERVICES
Entity type:Organization
Organization Name:COMMUNITY COUNSELING SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:M
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R,CASAC,NCAC
Authorized Official - Phone:631-471-3122
Mailing Address - Street 1:3281 VETERANS MEMORIAL HWY
Mailing Address - Street 2:SUITE E14
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7676
Mailing Address - Country:US
Mailing Address - Phone:631-471-3122
Mailing Address - Fax:631-471-3036
Practice Address - Street 1:3281 VETERANS MEMORIAL HWY
Practice Address - Street 2:SUITE E14
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-7676
Practice Address - Country:US
Practice Address - Phone:631-471-3122
Practice Address - Fax:631-471-3036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081111107101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01662344Medicaid