Provider Demographics
NPI:1548810088
Name:PD MENTAL HEALTH COUNSELING OF QUEENS COUNTY PLLC
Entity type:Organization
Organization Name:PD MENTAL HEALTH COUNSELING OF QUEENS COUNTY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIO
Authorized Official - Middle Name:
Authorized Official - Last Name:DESTVET
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:718-898-5600
Mailing Address - Street 1:7410 35TH AVE APT 107W
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-8105
Mailing Address - Country:US
Mailing Address - Phone:718-672-1538
Mailing Address - Fax:718-898-5700
Practice Address - Street 1:7410 35TH AVE APT 107W
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-8105
Practice Address - Country:US
Practice Address - Phone:718-672-1538
Practice Address - Fax:718-898-5700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty