| Mandala Psychological Services, P.c. | |
|
2785 W 5th St Apt 10e Brooklyn NY 11224-4612 | |
| (646) 415-1915 | |
| Not Available |
| Full Name | Mandala Psychological Services, P.c. |
|---|---|
| Speciality | Psychologist |
| Location | 2785 W 5th St Apt 10e, Brooklyn, New York |
| Authorized Official Name and Position | Yelena Razdolskaya (PSYCHOLOGIST) |
| Authorized Official Contact | 6464151915 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mandala Psychological Services, P.c. 2785 W 5th St Apt 10e Brooklyn NY 11224-4612 Ph: () - | Mandala Psychological Services, P.c. 2785 W 5th St Apt 10e Brooklyn NY 11224-4612 Ph: (646) 415-1915 |
| NPI Number | 1922164383 |
|---|---|
| Provider Enumeration Date | 12/29/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 7012011539 |
|---|---|
| Medicare Enrollment ID | O20070322000313 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922164383 | NPI | - | NPPES |
| 02821658 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 016210 (New York) | Primary |
| Provider Name | Yelena V Razdolskaya |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1396844924 PECOS PAC ID: 8022112531 Enrollment ID: I20070322000300 |
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