| Psychotherapy Latino Service Of Queens Lcsw Pllc | |
|
9231 57th Ave Ste L-b Elmhurst NY 11373-5024 | |
| (347) 639-0024 | |
| Not Available |
| Full Name | Psychotherapy Latino Service Of Queens Lcsw Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 9231 57th Ave Ste L-b, Elmhurst, New York |
| Authorized Official Name and Position | Evelyn Oudjehane (CEO) |
| Authorized Official Contact | 6469539259 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychotherapy Latino Service Of Queens Lcsw Pllc 9231 57th Ave Ste L-b Elmhurst NY 11373-5024 Ph: (347) 639-0024 | Psychotherapy Latino Service Of Queens Lcsw Pllc 9231 57th Ave Ste L-b Elmhurst NY 11373-5024 Ph: (347) 639-0024 |
| NPI Number | 1356909741 |
|---|---|
| Provider Enumeration Date | 05/31/2019 |
| Last Update Date | 10/30/2020 |
| Certification Date | 10/30/2020 |
| Medicare PECOS PAC ID | 0840696506 |
|---|---|
| Medicare Enrollment ID | O20210903000049 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356909741 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Evelyn Oudjehane |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396934543 PECOS PAC ID: 5294131959 Enrollment ID: I20210903000140 |
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