Provider Demographics
NPI:1184212516
Name:TAKE BACK CONTROL MENTAL HEALTH COUNSELING PLLC
Entity Type:Organization
Organization Name:TAKE BACK CONTROL MENTAL HEALTH COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELLA
Authorized Official - Middle Name:MARIAH
Authorized Official - Last Name:MASTRONARDI
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:917-508-2202
Mailing Address - Street 1:7033 KESSEL ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5843
Mailing Address - Country:US
Mailing Address - Phone:917-508-2202
Mailing Address - Fax:
Practice Address - Street 1:10818 QUEENS BLVD STE 704
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4755
Practice Address - Country:US
Practice Address - Phone:917-508-2202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)