Basic Information
| Provider Information | |||||||||
| NPI: | 1144626748 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CATHOLIC CHARITIES OF BROOKLYN AND QUEENS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9114 37TH AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSON HEIGHTS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113727920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187791831 | ||||||||
| FaxNumber: | 3475124150 | ||||||||
| Practice Location | |||||||||
| Address1: | 9114 37TH AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSON HEIGHTS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113727920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187791831 | ||||||||
| FaxNumber: | 3475124150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2014 | ||||||||
| LastUpdateDate: | 11/08/2014 | ||||||||
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| AuthorizedOfficialLastName: | SHEMI | ||||||||
| AuthorizedOfficialFirstName: | RONIT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CLINICAL MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7187791831 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.