MEDICARE: NATASHA FORTUNE

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0095241	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1144874322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATASHA FORTUNE

Provider Business Mailing Address
First Line	:	67 BURNS ST APT 6L
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-5226
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3418 NORTHERN BLVD FL 4
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-2236
Country	:	US
Telephone Number	:	646-812-0830
Fax Number	:

Authorized Official
Title or Position	:	OWNER, LMHC
Name	:	NATASHA FORTUNE
Credential	:	LMHC
Telephone Number	:	646-812-0830

Provider Enumeration Date	:	07/26/2019
Last Update Date	:	07/26/2019

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Directions to “NATASHA FORTUNE ” Practice Location

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