Healthcare Provider Details

I. General information

NPI: 1184550287
Provider Name (Legal Business Name): MENTAL HEALTH PROVIDERS OF WESTERN QUEENS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 91ST ST
JACKSON HEIGHTS NY
11372-7961
US

IV. Provider business mailing address

3708 91ST ST
JACKSON HEIGHTS NY
11372-7961
US

V. Phone/Fax

Practice location:
  • Phone: 718-779-2225
  • Fax:
Mailing address:
  • Phone: 348-771-0318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RIMJHIM DATT
Title or Position: SUPERVISOR
Credential: LCSW
Phone: 718-779-2263