MEDICARE: MI ALEGRIA PSYCHOTHERAPY LCSW 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1356931422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MI ALEGRIA PSYCHOTHERAPY LCSW PLLC

Provider Business Mailing Address
First Line	:	2125 ALBANY POST RD # 305
Second Line	:
City	:	MONTROSE
State	:	NY
Zip	:	10548-1447
Country	:	US
Telephone Number	:	914-362-9040
Fax Number	:	914-373-2366

Provider Business Practice Location Address
First Line	:	2125 ALBANY POST RD # 305
Second Line	:
City	:	MONTROSE
State	:	NY
Zip	:	10548-1447
Country	:	US
Telephone Number	:	914-362-9040
Fax Number	:	914-373-2366

Authorized Official
Title or Position	:	OWNER
Name	:	DIANA MARIA GONZALES-RICARD
Credential	:
Telephone Number	:	914-362-9040

Provider Enumeration Date	:	01/22/2021
Last Update Date	:	01/22/2021

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