Basic Information
| Provider Information | |||||||||
| NPI: | 1790193712 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMMUNITY PROGRAMS OF WESTCHESTER JEWISH COMMUNITY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 845 N BROADWAY | ||||||||
| Address2: | |||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106032403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147610600 | ||||||||
| FaxNumber: | 9147614728 | ||||||||
| Practice Location | |||||||||
| Address1: | 845 N BROADWAY | ||||||||
| Address2: | |||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106032403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147610600 | ||||||||
| FaxNumber: | 9147614728 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2014 | ||||||||
| LastUpdateDate: | 07/23/2014 | ||||||||
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| AuthorizedOfficialLastName: | GIULIANO | ||||||||
| AuthorizedOfficialFirstName: | MARY GRACE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | AED | ||||||||
| AuthorizedOfficialTelephone: | 9147610600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WESTCHESTER JEWISH COMMUNITY SERVICES | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | LMSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | N | Agencies | Case Management | 251S00000X | NY | N | Agencies | Community/Behavioral Health | 320900000X | NY | Y | Residential Treatment Facilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
No ID Information.