Cosmic Psych-Medx

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

Legal business name

COSMIC PSYCH-MEDX

Practice address

2065 E 54TH St Apt 2
Brooklyn, NY 11234-4750

Phone

(347) 465-0684

Fax

(347) 465-0684

NPI assigned

Nov 6, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Hatshepsut Nolene Kisa-Davidson, MSTOM

Title

Chief Clinician

Phone

(347) 465-0684

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1604620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604620800000",
    "number": "1326649146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 260031",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112260031",
            "telephone_number": "347-465-0684",
            "fax_number": "347-465-0684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2065 E 54TH ST APT 2",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112344750",
            "telephone_number": "347-465-0684",
            "fax_number": "347-465-0684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSMIC PSYCH-MEDX",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-06",
        "last_updated": "2020-11-06",
        "certification_date": "2020-11-06",
        "status": "A",
        "authorized_official_last_name": "KISA-DAVIDSON",
        "authorized_official_first_name": "HATSHEPSUT",
        "authorized_official_middle_name": "NOLENE",
        "authorized_official_title_or_position": "CHIEF CLINICIAN",
        "authorized_official_telephone_number": "347-465-0684",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MSTOM"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Glen Robert Cosman
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• Cesar A Cosme
• Rafaela Cosme
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• Catherine Cossentino
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• Marriage & Family Therapist in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Marriage & Family Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.