Provider Demographics
NPI:1386114692
Name:CHANEL V. TAZZA, MENTAL HEALTH COUNSELING, P.C.
Entity type:Organization
Organization Name:CHANEL V. TAZZA, MENTAL HEALTH COUNSELING, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHANEL
Authorized Official - Middle Name:VIVIANA
Authorized Official - Last Name:TAZZA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:646-456-0819
Mailing Address - Street 1:63 SCUDDERS LN
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-1535
Mailing Address - Country:US
Mailing Address - Phone:646-456-0819
Mailing Address - Fax:
Practice Address - Street 1:63 SCUDDERS LN
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-1535
Practice Address - Country:US
Practice Address - Phone:646-456-0819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-29
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1053510354OtherNPI TYPE I
NY1386114692OtherGROUP PRACTICE NPI
NY07679601Medicaid