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25 Elm Pl Fl 2 Brooklyn NY 11201-5355 | |
| (718) 802-0666 | |
| (718) 858-9493 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 25 Elm Pl Fl 2, Brooklyn, New York |
| Authorized Official Name and Position | Emory X. Brooks (PRESIDENT & CEO) |
| Authorized Official Contact | 7188020666 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
25 Elm Pl Fl 2 Brooklyn NY 11201-5355 Ph: (718) 802-0666 | 25 Elm Pl Fl 2 Brooklyn NY 11201-5355 Ph: (718) 802-0666 |
| NPI Number | 1003028549 |
|---|---|
| Provider Enumeration Date | 05/04/2007 |
| Last Update Date | 04/24/2018 |
| Medicare PECOS PAC ID | 5294960936 |
|---|---|
| Medicare Enrollment ID | O20131105000444 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003028549 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 7655100A (New York) | Primary |
| Provider Name | Di Fan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1851064018 PECOS PAC ID: 4789118852 Enrollment ID: I20241112002172 |
| Provider Name | Qinying Chu |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235791948 PECOS PAC ID: 2961936042 Enrollment ID: I20241112002698 |
| Provider Name | Peiyi Zhou |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275164600 PECOS PAC ID: 1355875444 Enrollment ID: I20241112002997 |
| Provider Name | Qingquan Yang |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073166575 PECOS PAC ID: 2860926953 Enrollment ID: I20241112003178 |
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