Healthcare Provider Details

I. General information

NPI: 1235799362
Provider Name (Legal Business Name): CHERISSE HUTCHERSON LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 BREWSTER ST # 569
GLEN COVE NY
11542-2549
US

IV. Provider business mailing address

5 BREWSTER ST # 569
GLEN COVE NY
11542-2549
US

V. Phone/Fax

Practice location:
  • Phone: 516-308-1214
  • Fax:
Mailing address:
  • Phone: 516-308-1214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number009507
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: