| Outpatient Mental Health Center | |
|
50 W. Hawthorne Avenue Valley Stream NY 11580 | |
| (516) 569-6600 | |
| (516) 374-2261 |
| Full Name | Outpatient Mental Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 50 W. Hawthorne Avenue, Valley Stream, New York |
| Authorized Official Name and Position | Jacqueline Rivera-herrera (VP OF FINANCE FOR CLINICAL SERVICES) |
| Authorized Official Contact | 3475424217 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Outpatient Mental Health Center 142-02 20th Avenue 3rd Floor Flushing NY 11351 Ph: (718) 559-0555 | Outpatient Mental Health Center 50 W. Hawthorne Avenue Valley Stream NY 11580 Ph: (516) 569-6600 |
| NPI Number | 1437262839 |
|---|---|
| Provider Enumeration Date | 08/17/2006 |
| Last Update Date | 03/04/2015 |
| Medicare PECOS PAC ID | 2668361353 |
|---|---|
| Medicare Enrollment ID | O20040311000882 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437262839 | NPI | - | NPPES |
| 00244817 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Joanne Walters |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629140082 PECOS PAC ID: 3476548512 Enrollment ID: I20040417000363 |
| Provider Name | Fred Lopez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164667259 PECOS PAC ID: 6305801036 Enrollment ID: I20041122001159 |
| Provider Name | Roger P Feldman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457420960 PECOS PAC ID: 7315962339 Enrollment ID: I20051010000317 |
| Provider Name | Mews Rousseau |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003825076 PECOS PAC ID: 2567480882 Enrollment ID: I20051108000142 |
| Provider Name | Andrea H Davanzo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578620332 PECOS PAC ID: 7911927058 Enrollment ID: I20051202000757 |
| Provider Name | Andrea R Carson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356410542 PECOS PAC ID: 1557383460 Enrollment ID: I20051220000499 |
| Provider Name | George Jory Wixsom |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1114094612 PECOS PAC ID: 5496778003 Enrollment ID: I20060110000632 |
| Provider Name | Veronica M Mcgoldrick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861578932 PECOS PAC ID: 9537179254 Enrollment ID: I20060426000181 |
| Provider Name | Renee Hamada |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548374366 PECOS PAC ID: 0941206049 Enrollment ID: I20061012000557 |
| Provider Name | Rita Kenn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578633723 PECOS PAC ID: 3274636105 Enrollment ID: I20070314000552 |
| Provider Name | Allison J Gibson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770790644 PECOS PAC ID: 5991805871 Enrollment ID: I20070706000076 |
| Provider Name | Laurie M Forman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962508291 PECOS PAC ID: 7214038769 Enrollment ID: I20070727000239 |
| Provider Name | Robert L Howard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730276700 PECOS PAC ID: 6709978000 Enrollment ID: I20070816000221 |
| Provider Name | Jeanette M Feingold |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699916403 PECOS PAC ID: 0143387621 Enrollment ID: I20090327000337 |
| Provider Name | Florence A Levine |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144464645 PECOS PAC ID: 6103976048 Enrollment ID: I20090615000435 |
| Provider Name | Valerie Gelber |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154541704 PECOS PAC ID: 1052457751 Enrollment ID: I20091012000000 |
| Provider Name | Janet L Meyer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932229861 PECOS PAC ID: 8921134289 Enrollment ID: I20100326000155 |
| Provider Name | Ruth Stern |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013003250 PECOS PAC ID: 5092831511 Enrollment ID: I20100922000008 |
| Provider Name | Brendan J Corey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114012077 PECOS PAC ID: 2062604424 Enrollment ID: I20101005000084 |
| Provider Name | Diane C Eaton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962574350 PECOS PAC ID: 8325231707 Enrollment ID: I20101018000877 |
| Provider Name | Joanne L Eagan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235283649 PECOS PAC ID: 2769670256 Enrollment ID: I20101228000554 |
| Provider Name | Pamela Wallace |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457493900 PECOS PAC ID: 3173702305 Enrollment ID: I20110120000482 |
| Provider Name | Victoria Capobianco |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1912117144 PECOS PAC ID: 6406025170 Enrollment ID: I20110815000421 |
| Provider Name | Carolyn Torres |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831239813 PECOS PAC ID: 3870754799 Enrollment ID: I20120419000422 |
| Provider Name | Laura Acero |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417094012 PECOS PAC ID: 0648425249 Enrollment ID: I20130306000000 |
| Provider Name | Corinne Loretta Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598947756 PECOS PAC ID: 9234368820 Enrollment ID: I20140130001096 |
| Provider Name | Jeffrey D Miller |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1790065209 PECOS PAC ID: 2769614668 Enrollment ID: I20140408000978 |
| Provider Name | Marianne E Brulhardt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952726564 PECOS PAC ID: 6305060757 Enrollment ID: I20140605000572 |
| Provider Name | Debra M Schwarz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588064976 PECOS PAC ID: 5597987982 Enrollment ID: I20141120000278 |
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