Healthcare Provider Details

I. General information

NPI: 1700160322
Provider Name (Legal Business Name): CORINE DEHGHANPISHEH LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 13TH ST STE 203 PARK SLOPE CENTER FOR MENTAL HEALTH
BROOKLYN NY
11215-6179
US

IV. Provider business mailing address

325 N END AVE APT 17D
NEW YORK NY
10282-1034
US

V. Phone/Fax

Practice location:
  • Phone: 718-788-5101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: