Provider Demographics
NPI:1922398239
Name:THERAPEUTIC CLINIC
Entity Type:Organization
Organization Name:THERAPEUTIC CLINIC
Other - Org Name:SELF-EMPLOYMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NPP( PSYCHIATRY )
Authorized Official - Prefix:MS
Authorized Official - First Name:ESTER
Authorized Official - Middle Name:PASCUAL
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:718-457-7998
Mailing Address - Street 1:3553 77TH ST # A-2B
Mailing Address - Street 2:JACKSON HEIGHTS
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-4551
Mailing Address - Country:US
Mailing Address - Phone:718-457-7998
Mailing Address - Fax:718-457-7998
Practice Address - Street 1:3553 77TH ST # A-2B
Practice Address - Street 2:JACKSON HEIGHTS
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-4551
Practice Address - Country:US
Practice Address - Phone:718-457-7998
Practice Address - Fax:718-457-7998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401266101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty