|
| |
|
177 East 122nd Street 2nd Floor New York NY 10035 | |
| (212) 360-7116 | |
| (212) 289-5647 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 177 East 122nd Street, New York, New York |
| Authorized Official Name and Position | Oksana Marants (VICE PRESIDENT FINANCIAL OFFICER) |
| Authorized Official Contact | 6466297363 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
463 Fashion Ave Fl 17 New York NY 10018-7595 Ph: (646) 629-7363 | 177 East 122nd Street 2nd Floor New York NY 10035 Ph: (212) 360-7116 |
| NPI Number | 1710055827 |
|---|---|
| Provider Enumeration Date | 11/30/2006 |
| Last Update Date | 02/15/2024 |
| Certification Date | 02/15/2024 |
| Medicare PECOS PAC ID | 9032651914 |
|---|---|
| Medicare Enrollment ID | O20240606002617 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710055827 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | CD010950 (New York) | Primary |
| Provider Name | Guy J Pean |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1255442513 PECOS PAC ID: 6204935356 Enrollment ID: I20070630000060 |
| Provider Name | Miriam Wax |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588081103 PECOS PAC ID: 6709175169 Enrollment ID: I20160525001632 |
| Provider Name | Amy H Leeds |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346622107 PECOS PAC ID: 3173864709 Enrollment ID: I20190409002351 |
| Provider Name | Stephanie M Maldonado |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1003694324 PECOS PAC ID: 3678010501 Enrollment ID: I20240808003504 |
| Provider Name | Hillary A Bowden |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1093293391 PECOS PAC ID: 3971041625 Enrollment ID: I20240813003534 |
| Provider Name | Anna Sompolski |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1336788538 PECOS PAC ID: 7315479953 Enrollment ID: I20241021001607 |
| Provider Name | Erika D Kocher |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912369836 PECOS PAC ID: 4183159627 Enrollment ID: I20241121000871 |
Joan Poelvoorde Lcsw Pc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 19 W 34th St, Penthouse, New York, NY 10001 Phone: 646-473-0138 Fax: 646-473-0138 | |
Laurie D Gilkes Lcsw Pc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 330 E 79th St, Suite 1g, New York, NY 10075 Phone: 212-737-0560 Fax: 212-737-0560 | |
National Federation For Autism Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 336 Fort Washington Ave, First Floor, New York, NY 10033 Phone: 917-783-2431 | |
Mary E Genkins Dsw Lcsw Pc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 430 E 63rd St, Apt 12l, New York, NY 10065 Phone: 212-838-9257 Fax: 212-207-6615 | |
Rethink Autism Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 19 W 21st Street, Suite 403, New York, NY 10010 Phone: 917-658-6313 | |