Healthcare Provider Details

I. General information

NPI: 1790319507
Provider Name (Legal Business Name): GEORGIA TRIMIKLINIOTIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2020
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3119 NEWTOWN AVE STE 502
ASTORIA NY
11102-1391
US

IV. Provider business mailing address

3119 NEWTOWN AVE STE 502
ASTORIA NY
11102-1391
US

V. Phone/Fax

Practice location:
  • Phone: 917-426-4001
  • Fax:
Mailing address:
  • Phone: 646-552-3496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number013512
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: