1386114692 NPI number — CHANEL V. TAZZA, MENTAL HEALTH COUNSELING, P.C.

Table of content: (NPI 1386114692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386114692 NPI number — CHANEL V. TAZZA, MENTAL HEALTH COUNSELING, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHANEL V. TAZZA, MENTAL HEALTH COUNSELING, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386114692
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
63 SCUDDERS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN HEAD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11545-1535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-456-0819
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
63 SCUDDERS LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLEN HEAD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11545-1535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-456-0819
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/29/2018

Additional Information

Authorized Official

Authorized Official Last Name:
TAZZA
Authorized Official First Name:
CHANEL
Authorized Official Middle Name:
VIVIANA
Authorized Official Title or Position:
MENTAL HEALTH COUNSELOR/OWNER
Authorized Official Telephone Number:
646-456-0819

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1053510354 . This is a "NPI TYPE I" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1386114692 . This is a "GROUP PRACTICE NPI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 07679601 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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