Provider Demographics
NPI:1649722059
Name:OPEN-MINDED COUNSELING, MARRAIGE AND FAMILY THERAPY, PLLC
Entity type:Organization
Organization Name:OPEN-MINDED COUNSELING, MARRAIGE AND FAMILY THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FELICITA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-739-7832
Mailing Address - Street 1:5731 MOSHOLU AVE
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2205
Mailing Address - Country:US
Mailing Address - Phone:212-739-7832
Mailing Address - Fax:
Practice Address - Street 1:5731 MOSHOLU AVE
Practice Address - Street 2:SUITE 2C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2205
Practice Address - Country:US
Practice Address - Phone:212-739-7832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000947-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty