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General NPI Number Information
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NPI Number | 1457663866
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Entity Type | Organization
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Legal Business Name | A QUIET PLACE PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 07/14/2010
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Last Update Date | 07/14/2010
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Provider Practice Location Address
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Address Line | 1013 E 13TH ST APT A10
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City | BROOKLYN
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State | NY
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Zip | 11230-4220
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Country | US
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Telephone | 646-662-9647
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Fax | 718-360-2279
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Provider Business Mailing Address
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Address Line | 1013 E 13TH ST APT A10
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City | BROOKLYN
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State | NY
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Zip | 11230-4220
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Country | US
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Telephone | 646-662-9647
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Fax | 718-360-2279
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Authorized Official
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Title or Position | OWNER
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Name | MS. IRINA VAKHNYANSKAYA
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Credential | PHD
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Telephone | 646-662-9647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 016487
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License Number State | NY
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