| Ignite Teen Treatment, Llc | |
|
6 Lamont Ct Brooklyn NY 11225-4506 | |
| (570) 203-9222 | |
| (570) 203-9477 |
| Full Name | Ignite Teen Treatment, Llc |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 6 Lamont Ct, Brooklyn, New York |
| Authorized Official Name and Position | Melissa Marshall (BILLING MANAGER) |
| Authorized Official Contact | 5702039222 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ignite Teen Treatment, Llc 270 Pierce St Ste 208 Kingston PA 18704-5141 Ph: (570) 203-9222 | Ignite Teen Treatment, Llc 6 Lamont Ct Brooklyn NY 11225-4506 Ph: (570) 203-9222 |
| NPI Number | 1114680634 |
|---|---|
| Provider Enumeration Date | 10/21/2021 |
| Last Update Date | 10/21/2021 |
| Certification Date | 10/21/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114680634 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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