Provider Demographics
NPI:1396936704
Name:TULCHINSKIY, MIKHAIL (PHD)
Entity type:Individual
Prefix:MR
First Name:MIKHAIL
Middle Name:
Last Name:TULCHINSKIY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63-26 99TH STREET
Mailing Address - Street 2:5A
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1914
Mailing Address - Country:US
Mailing Address - Phone:718-897-1570
Mailing Address - Fax:718-897-1570
Practice Address - Street 1:102-30 QUEENS BLVD.
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:917-318-0382
Practice Address - Fax:718-897-1570
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003767101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health