Bryson-Des Rault, Staci Glee

Bryson-Des Rault, Staci Glee is an sole proprietor health care provider with primary practice located at 90 N Walnut St , Massapequa NY 11758-3051. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Bryson-Des Rault, Staci Glee can be contacted via phone (631) 542-2501.

Contact Information

Primary practice address
90 N Walnut St Massapequa NY 11758-3051
Phone: (631) 542-2501
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 005197 New York
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X

Profile Details

NPI number 1457617920
LBN Legal business name Bryson-Des Rault, Staci Glee
Credentials LMHC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 9th, 2012
Last updated Sep 8th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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