Provider Demographics
NPI:1659097442
Name:KUSHMAKOVA, MICHELLE (LMHC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:KUSHMAKOVA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15611 AGUILAR AVE APT 8C
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2712
Mailing Address - Country:US
Mailing Address - Phone:516-253-6191
Mailing Address - Fax:
Practice Address - Street 1:15611 AGUILAR AVE APT 8C
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2712
Practice Address - Country:US
Practice Address - Phone:516-253-6191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014213101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health