Healthcare Provider Details

I. General information

NPI: 1235904533
Provider Name (Legal Business Name): MY TEAM: PSYCHOLOGY, SPEECH LANGUAGE PATHOLOGY, AND OCCUPATIONAL THERA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 11/17/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 COMMUNITY DR STE 207
MANHASSET NY
11030-3820
US

IV. Provider business mailing address

444 COMMUNITY DR STE 207
MANHASSET NY
11030-3820
US

V. Phone/Fax

Practice location:
  • Phone: 516-405-0020
  • Fax:
Mailing address:
  • Phone: 516-405-0020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. RENEE KROCHEK
Title or Position: MEMBER
Credential: PSYD
Phone: 516-405-0020