Individual
DR. MIA ROSE WISTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
270 LAFAYETTE ST STE 702, NEW YORK, NY 10012-3384
(914) 275-5138
Mailing address
150 RIVINGTON ST APT PHC, NEW YORK, NY 10002-5486
(914) 275-5138
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
024084
NY
Other
Enumeration date
02/17/2021
Last updated
02/17/2021
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