Doctor Name: | DR. MICHAEL PATRICH GUNNING |
NPI Number: | 1962735829 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | P67693 |
Business Practice Address: | 3771 Nesconset Hwy Suite 214 South Setauket, NY - 117201163 |
Business Phone Number: | 6317511420 |
Business Fax Number: | 6315090601 |
Mailing Address: | 3771 Nesconset Hwy, Suite 214 SOUTH SETAUKET |
State: | NY |
Postal Code: | 117201163 |
Phone Number: | 6317511420 |
Fax Number: | 6315090601 |
NPI Enumeration Date: | 09/10/2009 |
NPI Last Update Date: | 09/10/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | P67693 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |