St. Anne'S Medical Services
Psychologist, Addiction (Substance Use Disorder) in New York, NY. Organization (NPI-2).
NPI number1861923948
StatusActive
Last updated in NPPESMar 21, 2017
Details
- NPI
- 1861923948
- Entity type
- Organization (NPI-2)
- Legal business name
- St. Anne'S Medical Services
- Organization subpart
- No
- Enumeration date
- Mar 21, 2017
- Last updated
- Mar 21, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TA0400X | Psychologist, Addiction (Substance Use Disorder) | – | – | Yes |
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | – | – | |
| 101YM0800X | Counselor, Mental Health | – | – |
Practice location
64 Nagle AveNew York, NY 10040-1406
Phone 201-310-6947 · Fax 201-796-2205
Mailing address
10 Austin PlClifton, NJ 07014-1901
Phone 201-310-6947 · Fax 201-796-2205
Authorized official
Jeanine E. Graves
Administrator
2013106947
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