Basic Information
| Provider Information | |||||||||
| NPI: | 1083825194 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BROOKLYN PSYCHIATRIC CENTERS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 189 MONTAGUE ST | ||||||||
| Address2: | SUITE 418 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112013610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188755625 | ||||||||
| FaxNumber: | 7188756876 | ||||||||
| Practice Location | |||||||||
| Address1: | 189 MONTAGUE ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112013610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185969979 | ||||||||
| FaxNumber: | 7185433455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2007 | ||||||||
| LastUpdateDate: | 11/16/2007 | ||||||||
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| AuthorizedOfficialLastName: | STRAKER | ||||||||
| AuthorizedOfficialFirstName: | PAMELA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7188755625 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PH.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 00244284 | 05 | NY | MEDICAID |