| Minette Lcsw Psychotherapy Services, Pllc | |
|
2960 Grand Concourse Apt 3c Bronx NY 10458-1905 | |
| (201) 724-5489 | |
| Not Available |
| Full Name | Minette Lcsw Psychotherapy Services, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2960 Grand Concourse Apt 3c, Bronx, New York |
| Authorized Official Name and Position | Mary Taveras-garcia (LICENSE CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 2017245489 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Minette Lcsw Psychotherapy Services, Pllc 140 W 52nd St Bayonne NJ 07002-3120 Ph: (201) 724-5489 | Minette Lcsw Psychotherapy Services, Pllc 2960 Grand Concourse Apt 3c Bronx NY 10458-1905 Ph: (201) 724-5489 |
| NPI Number | 1013505783 |
|---|---|
| Provider Enumeration Date | 01/07/2021 |
| Last Update Date | 01/07/2021 |
| Certification Date | 01/06/2021 |
| Medicare PECOS PAC ID | 3678970217 |
|---|---|
| Medicare Enrollment ID | O20210923001865 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013505783 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Mary Taveras-garcia |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588788640 PECOS PAC ID: 2163732025 Enrollment ID: I20161221001590 |
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