Healthcare Provider Details

I. General information

NPI: 1386337111
Provider Name (Legal Business Name): REGO PARK COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6336 99TH ST
REGO PARK NY
11374-1979
US

IV. Provider business mailing address

6336 99TH ST
REGO PARK NY
11374-1979
US

V. Phone/Fax

Practice location:
  • Phone: 718-459-2558
  • Fax: 718-770-7676
Mailing address:
  • Phone: 718-459-2558
  • Fax: 718-770-7676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EMANUIL KALENDAREV
Title or Position: CEO
Credential:
Phone: 718-496-3834