| Lic Marriage And Family Therapy Pllc | |
|
3164 21st St # 121 Long Island City NY 11106-4573 | |
| (631) 365-9350 | |
| Not Available |
| Full Name | Lic Marriage And Family Therapy Pllc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 3164 21st St # 121, Long Island City, New York |
| Authorized Official Name and Position | Jennifer Disomma (MARRIAGE AND FAMILY THERAPIST) |
| Authorized Official Contact | 6313659350 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lic Marriage And Family Therapy Pllc 3164 21st St # 121 Long Island City NY 11106-4573 Ph: (631) 365-9350 | Lic Marriage And Family Therapy Pllc 3164 21st St # 121 Long Island City NY 11106-4573 Ph: (631) 365-9350 |
| NPI Number | 1306412077 |
|---|---|
| Provider Enumeration Date | 06/02/2021 |
| Last Update Date | 07/27/2023 |
| Certification Date | 07/27/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306412077 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
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