Provider Demographics
NPI:1265592273
Name:MIODOWNIK, CHERYL S (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:S
Last Name:MIODOWNIK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7118 136TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1912
Mailing Address - Country:US
Mailing Address - Phone:917-767-5247
Mailing Address - Fax:
Practice Address - Street 1:7118 136TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1912
Practice Address - Country:US
Practice Address - Phone:917-767-5247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001507-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health