Healthcare Provider Details

I. General information

NPI: 1538015565
Provider Name (Legal Business Name): PRIYANKA MODY MHC-LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2976 NORTHERN BLVD FL 2
LONG ISLAND CITY NY
11101-2829
US

IV. Provider business mailing address

2976 NORTHERN BLVD
LONG ISLAND CITY NY
11101-2822
US

V. Phone/Fax

Practice location:
  • Phone: 212-691-7554
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP141255
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: