Provider Demographics
NPI:1699505024
Name:FOTI, TREVOR M (MHC-LP)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:M
Last Name:FOTI
Suffix:
Gender:M
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 BEACH 138TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1341
Mailing Address - Country:US
Mailing Address - Phone:347-757-0362
Mailing Address - Fax:
Practice Address - Street 1:433 BEACH 138TH ST
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-1341
Practice Address - Country:US
Practice Address - Phone:347-757-0362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP130060101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health