Healthcare Provider Details

I. General information

NPI: 1023875804
Provider Name (Legal Business Name): CRESPO MENTAL HEALTH COUNSELING SERVICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3527 208TH STREET
BAYSIDE NY
11361
US

IV. Provider business mailing address

3527 208TH ST
BAYSIDE NY
11361-1329
US

V. Phone/Fax

Practice location:
  • Phone: 718-766-7160
  • Fax: 801-494-2245
Mailing address:
  • Phone: 646-251-6446
  • Fax: 801-494-2245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: RAQUEL A. CRESPO
Title or Position: OWNER/PROVIDER
Credential: LMHC, PC
Phone: 646-251-6446