MEDICARE: PEACEFUL WAY PSYCHOLOGY PLLC

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	103T00000X	Psychologist	016691	NY

General Provider Information

NPI Number	:	1215325261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACEFUL WAY PSYCHOLOGY PLLC

Provider Business Mailing Address
First Line	:	260 MADISON AVE
Second Line	:	SUITE 8006
City	:	NEW YORK
State	:	NY
Zip	:	10016-2400
Country	:	US
Telephone Number	:	212-335-0522
Fax Number	:	646-494-0410

Provider Business Practice Location Address
First Line	:	260 MADISON AVE
Second Line	:	SUITE 8006
City	:	NEW YORK
State	:	NY
Zip	:	10016-2400
Country	:	US
Telephone Number	:	212-335-0522
Fax Number	:	646-494-0410

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHRISTINE FERNANDEZ
Credential	:	PH.D.
Telephone Number	:	212-335-0511

Provider Enumeration Date	:	12/29/2014
Last Update Date	:	11/28/2023

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