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General NPI Number Information
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NPI Number | 1124835475
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Entity Type | Individual
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Provider Name | MARIA KHODAKOVSKI
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Gender | Female
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Dates
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Enumeration Date | 12/11/2024
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 2 HIGH ST
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City | MONTICELLO
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State | NY
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Zip | 12701-1343
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Country | US
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Telephone | 845-791-8800
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Fax | 845-791-7051
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Provider Business Mailing Address
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Address Line | 7292 STATE ROUTE 42
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City | GRAHAMSVILLE
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State | NY
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Zip | 12740-7004
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Country | US
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Telephone | 845-707-3933
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 554618-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | F407294
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License Number State | NY
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