NPIMap

Organization Active NPI

PD Mental Health Counseling of Queens County PLLC

  • Mental Health Counselor
  • Jackson Heights, NY
National Provider Identifier
1548810088
Registry record updated Sep 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
PD MENTAL HEALTH COUNSELING OF QUEENS COUNTY PLLC
Practice address
7410 35TH Ave Apt 107W
Jackson Heights, NY 11372-8105
Phone
(718) 672-1538
Fax
(718) 898-5700
NPI assigned
Sep 17, 2019
Last updated
Sep 17, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2019

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

Authorized official

Name
Patricio Destvet, LMHCNPI 1639220197
Title
Director
Phone
(718) 898-5600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU Primary

Addresses

Primary practice location

7410 35TH Ave Apt 107W
Jackson Heights, NY 11372-8105

Mailing address

7410 35TH Ave Apt 107W
Jackson Heights, NY 11372-8105
Phone (718) 672-1538

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL http://www.centerwesternqueens.com/ Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240523000113 NY Part B Supplier - Clinic/Group Practice 0446692404 Receives reassigned benefits from 8 practitioners
Practice locations: Jackson Heights, NY

National Provider Directory

National Provider Directory

Locations

7410 35th Ave
Apt 107W
Jackson Heights, NY 11372
Phone (718) 672-1538

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1568678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568678400000",
    "number": "1548810088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7410 35TH AVE APT 107W",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113728105",
            "telephone_number": "718-672-1538",
            "fax_number": "718-898-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7410 35TH AVE APT 107W",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113728105",
            "telephone_number": "718-672-1538",
            "fax_number": "718-898-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PD MENTAL HEALTH COUNSELING OF QUEENS COUNTY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-17",
        "last_updated": "2019-09-17",
        "status": "A",
        "authorized_official_last_name": "DESTVET",
        "authorized_official_first_name": "PATRICIO",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "718-898-5600",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "http://www.centerwesternqueens.com/",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "contentOtherDescription": "Address",
            "address_1": "7410 35th Ave Apt 107W",
            "city": "Jackson Heights",
            "state": "NY",
            "country_code": "US",
            "postal_code": "113728105",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jackson Heights, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.