Individual
DR. MICHAEL DEFALCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D
Contact information
Practice address
8737 PALERMO ST, HOLLIS, NY 11423-1221
(718) 598-3505
Mailing address
25 IRIS AVE, MERRICK, NY 11566-1111
(516) 414-2677
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
015570
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02726983
—
NY
01
—
381861
MHN
—
Enumeration date
12/26/2006
Last updated
07/08/2007
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