Basic Information
| Provider Information | |||||||||
| NPI: | 1851382188 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PARK SLOPE CENTER FOR MENTAL HEALTH, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 348 13TH ST | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112155004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187882461 | ||||||||
| FaxNumber: | 7187888274 | ||||||||
| Practice Location | |||||||||
| Address1: | 348 13TH ST | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112155004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187882461 | ||||||||
| FaxNumber: | 7187888274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2005 | ||||||||
| LastUpdateDate: | 04/17/2019 | ||||||||
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| AuthorizedOfficialLastName: | CASTORO | ||||||||
| AuthorizedOfficialFirstName: | MILADA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7187882461 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 01141097 | 05 | NY | MEDICAID |