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General NPI Number Information
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NPI Number | 1073029989
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Entity Type | Organization
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Legal Business Name | MT. KISCO MENTAL HEALTH COUNSELING P.C.
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Dates
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Enumeration Date | 12/15/2017
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Last Update Date | 12/15/2017
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Provider Practice Location Address
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Address Line | 40 W MAIN ST
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City | MOUNT KISCO
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State | NY
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Zip | 10549-1919
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Country | US
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Telephone | 914-217-8387
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Fax |
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Provider Business Mailing Address
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Address Line | 6 KNIFFEN RD
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City | KATONAH
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State | NY
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Zip | 10536-3159
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Country | US
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Telephone | 914-217-8387
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINA MARIE IZZO
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Credential | LMHC
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Telephone | 914-217-8387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 007874
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License Number State | NY
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