Provider Demographics
NPI:1679949036
Name:PROFESSIONAL CONSULTATION SERVICES FOR PSYCHOLOGY,SPEECH THERAPY, OCCU
Entity Type:Organization
Organization Name:PROFESSIONAL CONSULTATION SERVICES FOR PSYCHOLOGY,SPEECH THERAPY, OCCU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NOMINEE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHNOVICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-246-4893
Mailing Address - Street 1:271 NORTH AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5104
Mailing Address - Country:US
Mailing Address - Phone:914-235-3674
Mailing Address - Fax:
Practice Address - Street 1:271 NORTH AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5104
Practice Address - Country:US
Practice Address - Phone:914-235-3674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty