Provider Demographics
NPI:1093336125
Name:QUEENS NASSAU MENTAL HEALTH COUNSELING PLLC
Entity Type:Organization
Organization Name:QUEENS NASSAU MENTAL HEALTH COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ESHIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:KALAM
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:917-933-0584
Mailing Address - Street 1:40 SOUTH 16TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4915
Mailing Address - Country:US
Mailing Address - Phone:917-933-0584
Mailing Address - Fax:718-806-1435
Practice Address - Street 1:40 SOUTH 16TH STREET
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4915
Practice Address - Country:US
Practice Address - Phone:917-933-0584
Practice Address - Fax:718-806-1435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty