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General NPI Number Information
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NPI Number | 1417754672
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Entity Type | Individual
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Provider Name | ELIZABETH KONA MOMOH
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Gender |
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Dates
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Enumeration Date | 02/26/2025
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 159 BLEECKER ST FL 2
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City | NEW YORK
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State | NY
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Zip | 10012-1457
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Country | US
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Telephone | 917-382-8075
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Fax |
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Provider Business Mailing Address
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Address Line | 14530 231ST ST
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City | SPRINGFIELD GARDENS
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State | NY
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Zip | 11413-3929
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Country | US
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Telephone | 214-438-7089
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 015764
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License Number State | NY
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