Healthcare Provider Details

I. General information

NPI: 1558323295
Provider Name (Legal Business Name): COUNSELING PSYCHOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

984 N BROADWAY SUITE 411
YONKERS NY
10701-1318
US

IV. Provider business mailing address

984 N BROADWAY SUITE 411
YONKERS NY
10701-1318
US

V. Phone/Fax

Practice location:
  • Phone: 914-964-0336
  • Fax:
Mailing address:
  • Phone: 914-964-0336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number010055
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNY

VIII. Authorized Official

Name: DR. PAUL MOGLIA
Title or Position: PRESIDENT
Credential: PHD
Phone: 914-964-0336