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General NPI Number Information
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NPI Number | 1942951363
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Entity Type | Organization
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Legal Business Name | REENVISION MARRIAGE AND FAMILY THERAPY
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Dates
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Enumeration Date | 01/18/2022
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Last Update Date | 01/18/2022
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Provider Practice Location Address
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Address Line | 3328 164TH ST FL 1
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City | FLUSHING
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State | NY
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Zip | 11358-1442
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Country | US
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Telephone | 718-354-6738
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Fax |
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Provider Business Mailing Address
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Address Line | 4003 164TH ST UNIT 580161
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City | FLUSHING
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State | NY
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Zip | 11358-2686
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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 | OWNER/FOUNDER/THERAPIST
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Name | MRS. MICHELLE SENA PARK
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Credential | M.A., LMFT
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Telephone | 718-354-6738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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