Provider Demographics
NPI:1861696817
Name:COGNITIVE-BEHAVIORAL PSYCHOLOGY SERVICES OF LONG ISLAND
Entity type:Organization
Organization Name:COGNITIVE-BEHAVIORAL PSYCHOLOGY SERVICES OF LONG ISLAND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR & MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BARRY
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:2007-06-13
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009143-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty