Provider Demographics
NPI:1235904533
Name:MY TEAM: PSYCHOLOGY, SPEECH LANGUAGE PATHOLOGY, AND OCCUPATIONAL THERA
Entity Type:Organization
Organization Name:MY TEAM: PSYCHOLOGY, SPEECH LANGUAGE PATHOLOGY, AND OCCUPATIONAL THERA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:KROCHEK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:516-405-0020
Mailing Address - Street 1:444 COMMUNITY DR STE 207
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3820
Mailing Address - Country:US
Mailing Address - Phone:516-405-0020
Mailing Address - Fax:
Practice Address - Street 1:444 COMMUNITY DR STE 207
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3820
Practice Address - Country:US
Practice Address - Phone:516-405-0020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty