Basic Information
| Provider Information | |||||||||
| NPI: | 1548373921 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CATHOLIC CHARITIES NEIGHBORHOOD SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 191 JORALEMON ST | ||||||||
| Address2: | 14TH FLOOR | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112014306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187226000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 191 JORALEMON ST | ||||||||
| Address2: | 14TH FLOOR | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112014306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187226000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2006 | ||||||||
| LastUpdateDate: | 11/18/2014 | ||||||||
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| AuthorizedOfficialLastName: | WOLINETZ | ||||||||
| AuthorizedOfficialFirstName: | ALAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7187226130 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 6487019A | NY | N | Agencies | Community/Behavioral Health | 261QM0801X | 6487102A | NY | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM0801X | 6487101A | NY | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM0801X | 6487103A | NY | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM0801X | 6487100A | NY | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM0801X | 6487150A | NY | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 251S00000X | 6487302A | NY | N | Agencies | Community/Behavioral Health | 251S00000X | 6487301A | NY | N | Agencies | Community/Behavioral Health | 251S00000X | 6487300A | NY | N | Agencies | Community/Behavioral Health | 261QM0801X | 6487102D | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 00244624 | 05 | NY | MEDICAID |