MEDICARE: MIRLAINE BICHOTTE

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	103TM1800X	Intellectual & Developmental Disabilities Psychologist

General Provider Information

NPI Number	:	1649349861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRLAINE BICHOTTE

Provider Business Mailing Address
First Line	:	121 4TH AVENUE
Second Line	:
City	:	EAST ORANGE
State	:	NJ
Zip	:	07017
Country	:	US
Telephone Number	:	864-367-5905
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 4TH AVE
Second Line	:
City	:	EAST ORANGE
State	:	NJ
Zip	:	07017-4816
Country	:	US
Telephone Number	:	864-367-5905
Fax Number	:

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/21/2022

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Directions to “ MIRLAINE BICHOTTE ” Practice Location

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