MEDICARE: PSYCH MANAGED CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	251S00000X	Community/Behavioral Health Agency
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1396605952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCH MANAGED CARE LLC

Provider Business Mailing Address
First Line	:	2662 NATIONAL DR
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6917
Country	:	US
Telephone Number	:	917-797-9737
Fax Number	:

Provider Business Practice Location Address
First Line	:	317 MARTIN LUTHER KING JR DRIVE
Second Line	:	STORE #2
City	:	JERSEY CITY
State	:	NJ
Zip	:	07305
Country	:	US
Telephone Number	:	917-797-9737
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	JIMMY KOZLIK
Credential	:
Telephone Number	:	917-797-9737

Provider Enumeration Date	:	11/17/2025
Last Update Date	:	02/05/2026

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