MEDICARE: HARRIET SIEGEL CHERTOK LMHC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1023354537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARRIET SIEGEL CHERTOK LMHC, NCC

Provider Business Mailing Address
First Line	:	105 BIRCH DR
Second Line	:
City	:	ROSLYN
State	:	NY
Zip	:	11576-2304
Country	:	US
Telephone Number	:	516-313-7600
Fax Number	:	212-202-7556

Provider Business Practice Location Address
First Line	:	70 GLEN COVE RD STE 201
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-1730
Country	:	US
Telephone Number	:	516-399-0477
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2013
Last Update Date	:	01/02/2013

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