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General NPI Number Information
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NPI Number | 1639703481
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Entity Type | Organization
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Legal Business Name | BROOKLYN INTEGRATIVE PSYCHOLOGICAL SERVICES, P.L.L.C.
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Dates
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Enumeration Date | 03/02/2020
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Last Update Date | 04/23/2020
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Provider Practice Location Address
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Address Line | 117 DOBBIN ST STE 200
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City | BROOKLYN
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State | NY
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Zip | 11222-2803
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Country | US
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Telephone | 468-079-0586
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Fax |
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Provider Business Mailing Address
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Address Line | 117 DOBBIN ST STE 210
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City | BROOKLYN
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State | NY
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Zip | 11222-2803
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Country | US
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Telephone | 646-807-9058
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Fax | 646-396-0434
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MARIE MERCADO
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Credential |
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Telephone | 646-807-9058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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