Provider Demographics
NPI:1356475107
Name:MOUNTAINVIEW COUNSELING AND PSYCHOLOGICAL SERVICES, PC
Entity Type:Organization
Organization Name:MOUNTAINVIEW COUNSELING AND PSYCHOLOGICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HESCHELES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-981-5762
Mailing Address - Street 1:4250 VETERANS MEMORIAL HWY
Mailing Address - Street 2:SUITE 215 EAST
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4000
Mailing Address - Country:US
Mailing Address - Phone:631-981-5762
Mailing Address - Fax:631-981-5762
Practice Address - Street 1:4250 VETERANS MEMORIAL HWY
Practice Address - Street 2:SUITE 215 EAST
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4000
Practice Address - Country:US
Practice Address - Phone:631-981-5762
Practice Address - Fax:631-981-5762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01625167Medicaid
NYV14831Medicare PIN
NYV12332Medicare PIN