Provider Demographics
NPI:1194152892
Name:O'MEA, JOANNA TYCHANSKA (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:TYCHANSKA
Last Name:O'MEA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:TYCHANSKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:150 DOSORIS LN
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-1218
Mailing Address - Country:US
Mailing Address - Phone:516-801-7054
Mailing Address - Fax:
Practice Address - Street 1:150 DOSORIS LN
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-1218
Practice Address - Country:US
Practice Address - Phone:516-801-7054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018827103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool