Organization
PROFESSIONAL CONSULTATION SERVICES FOR PSYCHOLOGY,SPEECH THERAPY, OCCU
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JON MICHNOVICZ (NOMINEE OWNER)
(516) 246-4893
Entity
Organization
Contact information
Practice address
271 NORTH AVE, SUITE 111, NEW ROCHELLE, NY 10801-5104
(914) 235-3674
Mailing address
271 NORTH AVE, SUITE 111, NEW ROCHELLE, NY 10801-5104
(914) 235-3674
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
103TH0100X
Health Service Psychologist
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
08/19/2015
Last updated
07/08/2022
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