MEDICARE: UPPER MANHATTAN MENTAL HEALTH CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	32481	OTHER	NY	COMMUNITY PREMIER PLUS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	138894000	OTHER	NY	MAGELLAN, HMO
4	502650	OTHER	NY	VALUE OPTIONS, HMO
5	58P0551	OTHER	NY	NEW PRESBYTERIAN HMO
6	1060370	OTHER	NY	AFFINITY, HMO
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	000423458115	OTHER	NY	HEALTH PLUS, HMO

General Provider Information

NPI Number	:	1053335620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPPER MANHATTAN MENTAL HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	1727 AMSTERDAM AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-4611
Country	:	US
Telephone Number	:	212-694-9200
Fax Number	:	212-368-5608

Provider Business Practice Location Address
First Line	:	1727 AMSTERDAM AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-4611
Country	:	US
Telephone Number	:	212-694-9200
Fax Number	:	212-368-5608

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. WILLIAM WITHERSPOON
Credential	:	LCSW
Telephone Number	:	212-694-9200

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	10/07/2013

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