Provider Demographics
NPI:1295162287
Name:MORITOKI, MEGUMI (LMHC, CASAC)
Entity type:Individual
Prefix:MISS
First Name:MEGUMI
Middle Name:
Last Name:MORITOKI
Suffix:
Gender:F
Credentials:LMHC, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 E 138TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-1902
Mailing Address - Country:US
Mailing Address - Phone:718-665-7500
Mailing Address - Fax:718-655-4768
Practice Address - Street 1:6240 WOOD HEAVEN BOULEVARD
Practice Address - Street 2:REGO PARK
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:718-426-8117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23082101YA0400X
NY007693101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)