Organization
LITTLE PENGUIN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BORIS MIROCHNIK LCSW (DIRECTOR PSYCHOLOGIST)
(718) 967-1585
Entity
Organization
Contact information
Practice address
48 BLUEBERRY LANE, STATEN ISLAND, NY 10312
(718) 967-1585
(718) 967-1585
Mailing address
48 BLUEBERRY LANE, STATE ISLAND, NY 10312
(718) 967-1585
(718) 967-1585
Taxonomy
Speciality
Code
Description
License number
State
103TP2701X
Group Psychotherapy Psychologist
Primary
R065562
NY
Other
Enumeration date
11/09/2007
Last updated
11/09/2007
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