MEDICARE: WISE MIND MENTAL HEALTH COUNSELING, P.C.

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	006282-1	NY

General Provider Information

NPI Number	:	1346622388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISE MIND MENTAL HEALTH COUNSELING, P.C.

Provider Business Mailing Address
First Line	:	115 HENRY ST STE 1F
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-2512
Country	:	US
Telephone Number	:	718-207-3560
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 HENRY ST STE 1F
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-2512
Country	:	US
Telephone Number	:	718-207-3560
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SOFIA R TUCHAPSKY
Credential	:	RN, LMHC, NCC, CCMHC
Telephone Number	:	718-207-3560

Provider Enumeration Date	:	06/26/2015
Last Update Date	:	03/24/2020

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