NPIMap

Organization Active NPI

My Quiet Place, Mental Health Counseling P.C.

Doing business as Eclectic Psychotherapy Group

  • Mental Health Counselor
  • Staten Island, NY
National Provider Identifier
1932708682
Registry record updated Oct 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
MY QUIET PLACE, MENTAL HEALTH COUNSELING P.C.
Doing business as
Eclectic Psychotherapy Group
Practice address
115 Graham Blvd Apt a
Staten Island, NY 10305-4005
Phone
(917) 920-3411
NPI assigned
Oct 23, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2020

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

Authorized official

Name
Marina Krugolets, LMHCNPI 1033311709
Title
Clinical Director
Phone
(917) 920-3411

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 CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

115 Graham Blvd Apt a
Staten Island, NY 10305-4005

Mailing address

115 Graham Blvd Apt a
Staten Island, NY 10305-4005
Phone (917) 920-3411

Other names 1

  • Eclectic Psychotherapy Group Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1603411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603411200000",
    "number": "1932708682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 GRAHAM BLVD APT A",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103054005",
            "telephone_number": "917-920-3411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 GRAHAM BLVD APT A",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103054005",
            "telephone_number": "917-920-3411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY QUIET PLACE, MENTAL HEALTH COUNSELING P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-23",
        "last_updated": "2020-10-23",
        "certification_date": "2020-10-23",
        "status": "A",
        "authorized_official_last_name": "KRUGOLETS",
        "authorized_official_first_name": "MARINA",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "917-920-3411",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eclectic Psychotherapy Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 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.