Basic Information
| Provider Information | |||||||||
| NPI: | 1669524930 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LINCOLN MEDICAL AND MENTAL HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2245 BARKER AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104678052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3472753457 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2245 BARKER AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104678052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3472753457 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | VEGA | ||||||||
| AuthorizedOfficialFirstName: | EVELYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | SOCIAL WORKER | ||||||||
| AuthorizedOfficialTelephone: | 7185795657 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LCSW-R | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | R041008 | 01 | NY | SOCIAL WORK | OTHER |