| Silver Lake Support Services, Inc | |
|
201 Forest Ave Staten Island NY 10301-2763 | |
| (718) 815-3155 | |
| (718) 815-3151 |
| Full Name | Silver Lake Support Services, Inc |
|---|---|
| Speciality | Counselor |
| Location | 201 Forest Ave, Staten Island, New York |
| Authorized Official Name and Position | Avraham Schick (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7187209600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Silver Lake Support Services, Inc 201 Forest Ave Staten Island NY 10301-2763 Ph: (718) 815-3155 | Silver Lake Support Services, Inc 201 Forest Ave Staten Island NY 10301-2763 Ph: (718) 815-3155 |
| NPI Number | 1336363530 |
|---|---|
| Provider Enumeration Date | 04/12/2007 |
| Last Update Date | 06/17/2010 |
| Medicare PECOS PAC ID | 1658261037 |
|---|---|
| Medicare Enrollment ID | O20120615000147 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336363530 | NPI | - | NPPES |
| 02097574 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 061110987 (New York) | Primary |
| Provider Name | Dana Davino |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1275981045 PECOS PAC ID: 2264876994 Enrollment ID: I20240221000630 |
| Provider Name | Anthony Perrone |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1578955498 PECOS PAC ID: 2769820406 Enrollment ID: I20240401002228 |
| Provider Name | David Matthew Rick |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1528716123 PECOS PAC ID: 0547608283 Enrollment ID: I20240401002327 |
| Provider Name | Amanda Marie Tousson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1689022600 PECOS PAC ID: 7416398607 Enrollment ID: I20240520000943 |
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