Provider Demographics
NPI:1720487531
Name:PITSIKALIS, HARRY
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:
Last Name:PITSIKALIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 20TH ST
Mailing Address - Street 2:APT 2C
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-3527
Mailing Address - Country:US
Mailing Address - Phone:718-908-7481
Mailing Address - Fax:
Practice Address - Street 1:2011 20TH ST
Practice Address - Street 2:APT 2C
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-3527
Practice Address - Country:US
Practice Address - Phone:718-908-7481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020788103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical