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General NPI Number Information
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NPI Number | 1548810088
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Entity Type | Organization
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Legal Business Name | PD MENTAL HEALTH COUNSELING OF QUEENS COUNTY PLLC
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Dates
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Enumeration Date | 09/17/2019
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Last Update Date | 09/17/2019
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Provider Practice Location Address
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Address Line | 7410 35TH AVE APT 107W
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-8105
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Country | US
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Telephone | 718-672-1538
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Fax | 718-898-5700
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Provider Business Mailing Address
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Address Line | 7410 35TH AVE APT 107W
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-8105
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Country | US
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Telephone | 718-672-1538
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Fax | 718-898-5700
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Authorized Official
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Title or Position | DIRECTOR
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Name | PATRICIO DESTVET
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Credential | LMHC
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Telephone | 718-898-5600
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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 |
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License Number State |
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