| St. Vincent's Services, Inc. | |
|
66 Boerum Pl Brooklyn NY 11201-5705 | |
| (718) 422-2307 | |
| (718) 422-2271 |
| Full Name | St. Vincent's Services, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 66 Boerum Pl, Brooklyn, New York |
| Authorized Official Name and Position | Gaynell Brown (FISCAL ADMINISTRATOR) |
| Authorized Official Contact | 7184222307 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Vincent's Services, Inc. 66 Boerum Pl Brooklyn NY 11201-5705 Ph: (718) 422-2307 | St. Vincent's Services, Inc. 66 Boerum Pl Brooklyn NY 11201-5705 Ph: (718) 422-2307 |
| NPI Number | 1003015694 |
|---|---|
| Provider Enumeration Date | 07/13/2007 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 7012808793 |
|---|---|
| Medicare Enrollment ID | O20140609001198 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003015694 | NPI | - | NPPES |
| 02993433 | Medicaid | NY | |
| A100102752 | Other | MEDICARE PTAN | |
| 00272679 | Medicaid | NY |
| Provider Name | Jean Robert Harry Jacques |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154306868 PECOS PAC ID: 8628962966 Enrollment ID: I20040209001097 |
| Provider Name | Lillian Alu Gonzalez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023174836 PECOS PAC ID: 1658356563 Enrollment ID: I20040623000789 |
| Provider Name | Octavio Roman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215055512 PECOS PAC ID: 3072781814 Enrollment ID: I20110721000124 |
| Provider Name | Mira F Staco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235464298 PECOS PAC ID: 8921269234 Enrollment ID: I20120413000168 |
| Provider Name | Rodney Gwyn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154545325 PECOS PAC ID: 1557680022 Enrollment ID: I20150505000943 |
| Provider Name | Lynette R Green |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790064327 PECOS PAC ID: 8426330549 Enrollment ID: I20170126000119 |
| Provider Name | Domenica Macri |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750455705 PECOS PAC ID: 2365714854 Enrollment ID: I20170817002976 |
| Provider Name | Annie Reed |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053794487 PECOS PAC ID: 4789957473 Enrollment ID: I20170831000394 |
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