| Organization Name: | BOARO CONSULTATIONS NURSE PRACTITIONER IN PSYCHIATRY PC |
| NPI Number: | 1992975379 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DIANE BOARO (PRESIDENT) |
| Mailing Address: | 3771 Nesconset Hwy Suite 208b South Setauket |
| State: | NY US |
| Postal Code: | 117201163 |
| Phone Number: | 5167211976 |
| Fax Number: | 6316892055 |
| NPI Enumeration Date: | 03/03/2008 |
| NPI Last Update Date: | 03/03/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | F400809 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |