Basic Information
| Provider Information | |||||||||
| NPI: | 1639393101 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMMUNITY COUNSELING & MEDIATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TREATMENT ANOTHER PLACE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 W 31ST ST | ||||||||
| Address2: | 5TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100013403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125646006 | ||||||||
| FaxNumber: | 2125643440 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 W 31ST ST | ||||||||
| Address2: | 5TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100013403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125646006 | ||||||||
| FaxNumber: | 2125643440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BROOKS | ||||||||
| AuthorizedOfficialFirstName: | EMORY | ||||||||
| AuthorizedOfficialMiddleName: | XAVIER | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 7188020666 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 322D00000X | 7655430 | NY | Y | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children |
No ID Information.