Individual
CHARLES MIEZEJESKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1745 BROADWAY, 17 FL, NEW YORK, NY 10019-4640
(212) 851-8100
(212) 537-0102
Mailing address
556 COLLEGE AVE, STATEN ISLAND, NY 10302-2510
(718) 744-5941
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6368
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01676984
—
NY
Enumeration date
07/31/2006
Last updated
11/11/2021
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