Provider Demographics
NPI:1205202991
Name:MESTECHKINA, TATYANA (PHD)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:MESTECHKINA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4942
Mailing Address - Country:US
Mailing Address - Phone:917-605-2120
Mailing Address - Fax:
Practice Address - Street 1:928 BROADWAY STE 300
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-8158
Practice Address - Country:US
Practice Address - Phone:917-605-2120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021204-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical