Provider Demographics
NPI:1669016333
Name:MARRIAGE AND MENTAL HEALTH COUNSELING, PC
Entity Type:Organization
Organization Name:MARRIAGE AND MENTAL HEALTH COUNSELING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETERSEL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT & LMHC
Authorized Official - Phone:845-499-2482
Mailing Address - Street 1:3 REXAL COURT
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956
Mailing Address - Country:US
Mailing Address - Phone:845-499-2482
Mailing Address - Fax:
Practice Address - Street 1:3 REXAL COURT
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956
Practice Address - Country:US
Practice Address - Phone:845-499-2482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARRIAGE AND MENTAL HEALTH COUNSELING, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty