Provider Demographics
NPI:1003381708
Name:MN PSYCHOLOGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:MN PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NUCCITELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-221-5800
Mailing Address - Street 1:58 BUFFALO AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-3704
Mailing Address - Country:US
Mailing Address - Phone:718-221-5800
Mailing Address - Fax:
Practice Address - Street 1:2255 CROPSEY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-5705
Practice Address - Country:US
Practice Address - Phone:718-221-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty