MEDICARE: MS. PATRICIA KISSI M.A

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	:	1265631261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA KISSI M.A

Provider Business Mailing Address
First Line	:	716 E 224TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-4206
Country	:	US
Telephone Number	:	347-439-5772
Fax Number	:

Provider Business Practice Location Address
First Line	:	716 E 224TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-4206
Country	:	US
Telephone Number	:	347-439-5772
Fax Number	:

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

Provider Enumeration Date	:	07/11/2007
Last Update Date	:	10/01/2010

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