Healthcare Provider Details

I. General information

NPI: 1447786751
Provider Name (Legal Business Name): MENTAL HEALTH COUNSELING OF STATEN ISLAND, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2017
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 VICTORY BLVD
STATEN ISLAND NY
10314-6612
US

IV. Provider business mailing address

2460 VICTORY BLVD
STATEN ISLAND NY
10314-6612
US

V. Phone/Fax

Practice location:
  • Phone: 347-733-9964
  • Fax: 212-877-5504
Mailing address:
  • Phone: 347-733-9964
  • Fax: 212-877-5504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number007543
License Number StateNY

VIII. Authorized Official

Name: MRS. LUCIA FALCONE
Title or Position: OWNER
Credential: LMHC
Phone: 347-733-9964