MEDICARE: TS 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
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1306659339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TS PSYCHOLOGICAL SERVICES PLLC

Provider Business Mailing Address
First Line	:	1866 W 5TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-2638
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1866 W 5TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-2638
Country	:	US
Telephone Number	:	347-316-8056
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. TATYANA SHCHUPAK
Credential	:	PH.D.
Telephone Number	:	347-316-8056

Provider Enumeration Date	:	01/31/2025
Last Update Date	:	02/14/2025

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