=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760291264
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KWASHEE TOTIMEH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2024
-----------------------------------------------------
Last Update Date | 12/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 276 5TH AVE FL 5
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10001-4527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-828-7473
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 306 OLD BERGEN RD APT 2
-----------------------------------------------------
City | JERSEY CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07305-2771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-803-7353
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 017098
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------