Basic Information
| Provider Information | |||||||||
| NPI: | 1730173402 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY SETTLEMENT SOCIETY OF NEW YORK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 184 ELDRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100022924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126749120 | ||||||||
| FaxNumber: | 2122545334 | ||||||||
| Practice Location | |||||||||
| Address1: | 184 ELDRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100022924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126749120 | ||||||||
| FaxNumber: | 2122545334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2005 | ||||||||
| LastUpdateDate: | 08/14/2015 | ||||||||
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| AuthorizedOfficialLastName: | TOBING | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | ASST EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2124534515 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LCSW ACSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 01427196 | 05 | NY | MEDICAID |