MEDICARE: MISS MEGUMI MORITOKI LMHC, CASAC

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	23082	NY
2	101YM0800X	Mental Health Counselor	007693	NY

General Provider Information

NPI Number	:	1295162287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MEGUMI MORITOKI LMHC, CASAC

Provider Business Mailing Address
First Line	:	804 E 138TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10454-1902
Country	:	US
Telephone Number	:	718-665-7500
Fax Number	:	718-655-4768

Provider Business Practice Location Address
First Line	:	6240 WOOD HEAVEN BOULEVARD
Second Line	:	REGO PARK
City	:	NEW YORK
State	:	NY
Zip	:	11374
Country	:	US
Telephone Number	:	718-426-8117
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2013
Last Update Date	:	05/15/2018

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