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NPI Code Detail

MEDICARE: MIRA VASJARI

MEDICARE: MIRA VASJARI
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1376140467
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRA VASJARI
Provider Business Mailing Address
First Line : 6824 64TH PL
Second Line :
City : RIDGEWOOD
State : NY
Zip : 11385-5250
Country : US
Telephone Number : 646-750-5487
Fax Number :
Provider Business Practice Location Address
First Line : 5913 GROVE ST
Second Line :
City : RIDGEWOOD
State : NY
Zip : 11385-2647
Country : US
Telephone Number : 646-456-0819
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2020
Last Update Date : 10/02/2020

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Directions to “ MIRA VASJARI ” Practice Location

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