| Queens Psychotherapy Lcsw Pc | |
|
8786 188th St Fl 1 Jamaica NY 11423-1131 | |
| (917) 267-8359 | |
| Not Available |
| Full Name | Queens Psychotherapy Lcsw Pc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 8786 188th St Fl 1, Jamaica, New York |
| Authorized Official Name and Position | Matthew Thomas Diner (OWNER) |
| Authorized Official Contact | 9172678359 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Queens Psychotherapy Lcsw Pc 8786 188th St Fl 1 Jamaica NY 11423-1131 Ph: (917) 267-8359 | Queens Psychotherapy Lcsw Pc 8786 188th St Fl 1 Jamaica NY 11423-1131 Ph: (917) 267-8359 |
| NPI Number | 1407401011 |
|---|---|
| Provider Enumeration Date | 08/09/2019 |
| Last Update Date | 08/09/2019 |
| Medicare PECOS PAC ID | 2466862453 |
|---|---|
| Medicare Enrollment ID | O20210419002537 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407401011 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Matthew T Diner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518354984 PECOS PAC ID: 2264796804 Enrollment ID: I20180507000375 |
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