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NPI Code Detail

MEDICARE: CHELSEA MOJALLALI

MEDICARE: CHELSEA MOJALLALI
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 Counselor017259NY

General Provider Information

NPI Number : 1811752819
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHELSEA MOJALLALI
Provider Business Mailing Address
First Line : 71 EVERGREEN LN
Second Line :
City : EAST PATCHOGUE
State : NY
Zip : 11772-5805
Country : US
Telephone Number : 631-609-7002
Fax Number :
Provider Business Practice Location Address
First Line : 4109 SUNRISE HWY
Second Line :
City : BOHEMIA
State : NY
Zip : 11716-4600
Country : US
Telephone Number : 631-552-5524
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2024
Last Update Date : 01/05/2026

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Directions to “ CHELSEA MOJALLALI ” Practice Location

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