Healthcare Provider Details

I. General information

NPI: 1124825237
Provider Name (Legal Business Name): MN PSYCHOLOGICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 CROPSEY AVE
BROOKLYN NY
11214-5705
US

IV. Provider business mailing address

5705 FOSTER AVE
BROOKLYN NY
11234-1001
US

V. Phone/Fax

Practice location:
  • Phone: 718-266-5858
  • Fax:
Mailing address:
  • Phone: 718-221-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL NUCCITELLI
Title or Position: OWNER
Credential: PHD
Phone: 718-221-5800