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NPI Code Detail

MEDICARE: DR. JOSEPH J FAILLACE PHD LMHC

MEDICARE: DR. JOSEPH J FAILLACE PHD LMHC
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
1101YM0800XMental Health Counselor001717NY

General Provider Information

NPI Number : 1780742056
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOSEPH J FAILLACE PHD LMHC
Provider Business Mailing Address
First Line : 34-21 77TH ST
Second Line :
City : JACKSON HTS
State : NY
Zip : 11372-6143
Country : US
Telephone Number : 718-779-2434
Fax Number :
Provider Business Practice Location Address
First Line : 3764 72ND ST
Second Line : OCNI
City : JACKSON HTS
State : NY
Zip : 11372-6143
Country : US
Telephone Number : 718-335-3434
Fax Number : 718-335-4731
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2006
Last Update Date : 07/08/2007

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