Healthcare Provider Details

I. General information

NPI: 1689478919
Provider Name (Legal Business Name): FATIM-BATROU CISSE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 15B SANFORD AVE.
FLUSHING NY
11355-0000
US

IV. Provider business mailing address

140 15B SANFORD AVE.
FLUSHING NY
11355-0000
US

V. Phone/Fax

Practice location:
  • Phone: 718-651-7770
  • Fax:
Mailing address:
  • Phone: 646-744-4504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberP144631
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: