Provider Demographics
NPI:1386957801
Name:PD MENTAL HEALTH COUNSELING OF WESTERN QUEENS PLLC
Entity type:Organization
Organization Name:PD MENTAL HEALTH COUNSELING OF WESTERN QUEENS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICIO
Authorized Official - Middle Name:
Authorized Official - Last Name:DESTVET
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:718-672-1538
Mailing Address - Street 1:7410 35TH AVE
Mailing Address - Street 2:SUITE 107 W
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-8197
Mailing Address - Country:US
Mailing Address - Phone:718-672-1538
Mailing Address - Fax:718-429-0713
Practice Address - Street 1:7410 35TH AVE
Practice Address - Street 2:SUITE 107 W
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-8197
Practice Address - Country:US
Practice Address - Phone:718-672-1538
Practice Address - Fax:718-429-0713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001402101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty