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NPI Code Detail

MEDICARE: MN PSYCHOLOGICAL SERVICES PLLC

MEDICARE: MN PSYCHOLOGICAL SERVICES PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist

General Provider Information

NPI Number : 1003381708
Entity Type Code : Organization
Provider Name (Legal Business Name) : MN PSYCHOLOGICAL SERVICES PLLC
Provider Business Mailing Address
First Line : 5705 FOSTER AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11234-1001
Country : US
Telephone Number : 718-221-5800
Fax Number :
Provider Business Practice Location Address
First Line : 2255 CROPSEY AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11214-5705
Country : US
Telephone Number : 718-221-5800
Fax Number :
Authorized Official
Title or Position : MEMBER
Name : MICHAEL NUCCITELLI
Credential :
Telephone Number : 718-221-5800
Provider Enumeration Date : 10/09/2018
Last Update Date : 08/09/2024

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