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General NPI Number Information
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NPI Number | 1649135781
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Entity Type | Individual
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Provider Name | KELLY MISEVICH
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Gender | Female
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Dates
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Enumeration Date | 12/22/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 226 7TH ST
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City | GARDEN CITY
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State | NY
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Zip | 11530-5723
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Country | US
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Telephone | 516-825-6567
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Fax |
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Provider Business Mailing Address
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Address Line | 31 EUGENE DR
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City | KINGS PARK
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State | NY
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Zip | 11754-4713
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Country | US
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Telephone |
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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 | P127714-01
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License Number State | NY
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