| Sealight Coalition | |
|
26 Court St 2011 Brooklyn NY 11242-0103 | |
| (718) 624-3192 | |
| Not Available |
| Full Name | Sealight Coalition |
|---|---|
| Speciality | Psychologist |
| Location | 26 Court St, Brooklyn, New York |
| Authorized Official Name and Position | Mariam Garuba (FOUNDER) |
| Authorized Official Contact | 9739085642 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sealight Coalition 26 Court St Brooklyn NY 11242-0103 Ph: (718) 624-3192 | Sealight Coalition 26 Court St 2011 Brooklyn NY 11242-0103 Ph: (718) 624-3192 |
| NPI Number | 1871956573 |
|---|---|
| Provider Enumeration Date | 03/30/2016 |
| Last Update Date | 03/30/2016 |
| Medicare PECOS PAC ID | 4789936303 |
|---|---|
| Medicare Enrollment ID | O20181010000527 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871956573 | NPI | - | NPPES |
| 1275748261 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TP0016X | Psychologist - Prescribing (medical) | 268153 (New York) | Primary |
| Provider Name | Mariam I Garuba |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275748261 PECOS PAC ID: 1759536576 Enrollment ID: I20180710000211 |
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