Provider Demographics
NPI:1326195496
Name:VASSILATOS, ALEX (MA,, CRC, LMHC)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:
Last Name:VASSILATOS
Suffix:
Gender:M
Credentials:MA,, CRC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4135 45TH ST APT 3C
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-1913
Mailing Address - Country:US
Mailing Address - Phone:917-334-7714
Mailing Address - Fax:
Practice Address - Street 1:4343 BOWNE ST
Practice Address - Street 2:QUEENS COUNSELING SERVICES
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3039
Practice Address - Country:US
Practice Address - Phone:718-461-6393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000140101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health