MEDICARE: SOTELO-DYNEGA 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1407653918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOTELO-DYNEGA PSYCHOLOGICAL SERVICES, PLLC

Provider Business Mailing Address
First Line	:	70 GLEN COVE RD STE LL4
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-1722
Country	:	US
Telephone Number	:	347-610-1036
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 GLEN COVE RD STE LL4
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-1722
Country	:	US
Telephone Number	:	347-610-1036
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST/MEMBER-MANAGER
Name	:	DR. MARLENE SOTELO-DYNEGA
Credential	:	PSYD
Telephone Number	:	347-610-1036

Provider Enumeration Date	:	03/03/2025
Last Update Date	:	03/03/2025

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