Healthcare Provider Details

I. General information

NPI: 1982147310
Provider Name (Legal Business Name): MILESTONES PSYCHOLOGY GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2016
Last Update Date: 12/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MADISON AVE STE 2536
NEW YORK NY
10010-2202
US

IV. Provider business mailing address

41 MADISON AVE STE 2536
NEW YORK NY
10010-2202
US

V. Phone/Fax

Practice location:
  • Phone: 917-482-6782
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: RAVIL SHARMA
Title or Position: MANAGING MEMBER
Credential: PSY.D.
Phone: 917-482-6782