Basic Information
| Provider Information | |||||||||
| NPI: | 1396047676 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE GUIDANCE CENTER-CDTC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 SICKLES AVE | ||||||||
| Address2: | |||||||||
| City: | NEW ROCHELLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 108014030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146321374 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20 SICKLES AVE | ||||||||
| Address2: | |||||||||
| City: | NEW ROCHELLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 108014030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146321374 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2010 | ||||||||
| LastUpdateDate: | 11/19/2010 | ||||||||
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| AuthorizedOfficialLastName: | GELLES | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9146364440 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | THE GUIDANCE CENTER INC | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2800X | 613936 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Methadone Clinic |
No ID Information.