| Resiliency Express Lcsw Pc | |
|
74-05 Metropolitan Avenue 2nd Floor Middle Village NY 11379 | |
| (718) 201-2456 | |
| Not Available |
| Full Name | Resiliency Express Lcsw Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 74-05 Metropolitan Avenue, Middle Village, New York |
| Authorized Official Name and Position | Michelle Rodriguez (PRESIDENT) |
| Authorized Official Contact | 7189097742 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Resiliency Express Lcsw Pc 150-51 Village Road Unit 55a Jamaica NY 11432 Ph: (718) 909-7742 | Resiliency Express Lcsw Pc 74-05 Metropolitan Avenue 2nd Floor Middle Village NY 11379 Ph: (718) 201-2456 |
| NPI Number | 1104225002 |
|---|---|
| Provider Enumeration Date | 08/15/2014 |
| Last Update Date | 08/15/2014 |
| Medicare PECOS PAC ID | 3870712227 |
|---|---|
| Medicare Enrollment ID | O20150403000016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104225002 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 076034-1 (New York) | Primary |
| Provider Name | Michelle Rodriguez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972625572 PECOS PAC ID: 4284774431 Enrollment ID: I20091218000198 |
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