MEDICARE: COSMIC PSYCH-MEDX

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1326649146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COSMIC PSYCH-MEDX

Provider Business Mailing Address
First Line	:	PO BOX 260031
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-0031
Country	:	US
Telephone Number	:	347-465-0684
Fax Number	:	347-465-0684

Provider Business Practice Location Address
First Line	:	2065 E 54TH ST APT 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4750
Country	:	US
Telephone Number	:	347-465-0684
Fax Number	:	347-465-0684

Authorized Official
Title or Position	:	CHIEF CLINICIAN
Name	:	MS. HATSHEPSUT NOLENE KISA-DAVIDSON
Credential	:	MSTOM
Telephone Number	:	347-465-0684

Provider Enumeration Date	:	11/06/2020
Last Update Date	:	11/06/2020

Similar Medicare Providers

1154561868 — MRS. ELLEN D. BLACKMAN CCC/SLP
Practice Location Address:

4750 BEDFORD AVE , 1K
BROOKLYN, NY
11235-2651

Practice Phone: 917-692-7445
Practice Fax:

1912241852 — BASHA TEITELBAUM MSED
Practice Location Address:

5614 15TH AVE , #5F
BROOKLYN, NY
11219-4750

Practice Phone: 718-853-5126
Practice Fax: 718-514-8693

1700205465 — MARINA LITVINSKAYA
Practice Location Address:

4750 BEDFORD AVE , 7D
BROOKLYN, NY
11235-2651

Practice Phone: 347-407-0787
Practice Fax:

1326419235 — SJOVYT FREEMAN
Practice Location Address:

163 OCEAN AVE APT A5
BROOKLYN, NY
11225-4750

Practice Phone: 718-284-2742
Practice Fax:

1427506377 — MISS VALERIE AYR M.ED
Practice Location Address:

4750 BEDFORD AVE , SUITE #7K
BROOKLYN, NY
11235-2651

Practice Phone: 917-862-7248
Practice Fax:

1306350194 — MEDICAL LABORATORY SERVICE INC
Practice Location Address:

2324 BROOKLYN RD
JACKSON, MI
49203-4750

Practice Phone: 517-997-1000
Practice Fax:

Directions to “COSMIC PSYCH-MEDX ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.