Provider Demographics
NPI:1023875804
Name:CRESPO MENTAL HEALTH COUNSELING SERVICE PLLC
Entity type:Organization
Organization Name:CRESPO MENTAL HEALTH COUNSELING SERVICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRESPO
Authorized Official - Suffix:
Authorized Official - Credentials:L,HC
Authorized Official - Phone:646-251-6446
Mailing Address - Street 1:3527 208TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1329
Mailing Address - Country:US
Mailing Address - Phone:347-417-6490
Mailing Address - Fax:
Practice Address - Street 1:2441 41ST ST # 1043
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3363
Practice Address - Country:US
Practice Address - Phone:718-766-7160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)