Basic Information
| Provider Information | |||||||||
| NPI: | 1942411632 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CATHOLIC CHARITIES | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | BUILDERS FOR FAMILY AND YOUTH | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 516 E FULTON ST | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115612417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183376850 | ||||||||
| FaxNumber: | 7188683782 | ||||||||
| Practice Location | |||||||||
| Address1: | 1329 BEACH CHANNEL DR | ||||||||
| Address2: | |||||||||
| City: | FAR ROCKAWAY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 116913211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183376850 | ||||||||
| FaxNumber: | 7188683850 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TURKEL | ||||||||
| AuthorizedOfficialFirstName: | DEBBIE | ||||||||
| AuthorizedOfficialMiddleName: | ANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | CLINICAL MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7183376850 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | B.S.,C.A.S.A.C. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 2213 | 01 | NY | C.A.S.A.C. | OTHER |