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General NPI Number Information
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NPI Number | 1679949036
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL CONSULTATION SERVICES FOR PSYCHOLOGY,SPEECH THERAPY, OCCU
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 07/08/2022
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Provider Practice Location Address
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Address Line | 271 NORTH AVE SUITE 111
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-5104
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Country | US
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Telephone | 914-235-3674
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Fax |
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Provider Business Mailing Address
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Address Line | 271 NORTH AVE SUITE 111
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-5104
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Country | US
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Telephone | 914-235-3674
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Fax |
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Authorized Official
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Title or Position | NOMINEE OWNER
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Name | JON MICHNOVICZ
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Credential |
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Telephone | 516-246-4893
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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