Organization
COSMIC PSYCH-MEDX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. HATSHEPSUT NOLENE KISA-DAVIDSON MSTOM (CHIEF CLINICIAN)
(347) 465-0684
Entity
Organization
Contact information
Practice address
2065 E 54TH ST APT 2, BROOKLYN, NY 11234-4750
(347) 465-0684
(347) 465-0684
Mailing address
PO BOX 260031, BROOKLYN, NY 11226-0031
(347) 465-0684
(347) 465-0684
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
11/06/2020
Last updated
11/06/2020
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