Basic Information
| Provider Information | |||||||||
| NPI: | 1033579917 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE CHILD CENTER OF NY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1761 3 AVENUE APT 12F | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182978000 | ||||||||
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| Address1: | 1761 3RD AVE APT 12F | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100296818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182978000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2016 | ||||||||
| LastUpdateDate: | 03/04/2016 | ||||||||
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| AuthorizedOfficialLastName: | CABAN | ||||||||
| AuthorizedOfficialFirstName: | MIOSOTTE | ||||||||
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| AuthorizedOfficialTitleorPosition: | FAMILY THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 7182978000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CASAC-T | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 06308 | NY | Y | Agencies | Community/Behavioral Health |
No ID Information.