| Mind In Motion Psychological Services, Pllc | |
|
4332 22nd St Ste 203 Long Island City NY 11101-5077 | |
| (347) 352-3971 | |
| Not Available |
| Full Name | Mind In Motion Psychological Services, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4332 22nd St Ste 203, Long Island City, New York |
| Authorized Official Name and Position | Jihee Cho (CO-DIRECTOR) |
| Authorized Official Contact | 9172431667 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mind In Motion Psychological Services, Pllc 4332 22nd St Ste 203 Long Island City NY 11101-5077 Ph: () - | Mind In Motion Psychological Services, Pllc 4332 22nd St Ste 203 Long Island City NY 11101-5077 Ph: (347) 352-3971 |
| NPI Number | 1093362816 |
|---|---|
| Provider Enumeration Date | 08/26/2019 |
| Last Update Date | 10/28/2019 |
| Medicare PECOS PAC ID | 0941634695 |
|---|---|
| Medicare Enrollment ID | O20200106000994 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093362816 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Jihee Cho |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1013497205 PECOS PAC ID: 4587098231 Enrollment ID: I20200107001297 |
| Provider Name | Damien Tilliman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1588205272 PECOS PAC ID: 3678907326 Enrollment ID: I20210324002750 |
| Provider Name | Jonathan D. Metivier |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1366293201 PECOS PAC ID: 5799228037 Enrollment ID: I20240614003226 |
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