Healthcare Provider Details

I. General information

NPI: 1790926111
Provider Name (Legal Business Name): MS. SANDY MOMPOINT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2009
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11835 QUEENS BLVD STE 1630
FOREST HILLS NY
11375-7256
US

IV. Provider business mailing address

11835 QUEENS BLVD STE 1630
FOREST HILLS NY
11375-7256
US

V. Phone/Fax

Practice location:
  • Phone: 718-736-3554
  • Fax: 718-502-5334
Mailing address:
  • Phone: 718-736-3554
  • Fax: 718-502-5334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number010278
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: