MEDICARE: BROOKLYN PSYCHIATRIC CENTERS, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568555738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKLYN PSYCHIATRIC CENTERS, INC

Provider Business Mailing Address
First Line	:	189 MONTAGUE ST
Second Line	:	SUITE 418
City	:	BROOKLYN
State	:	NY
Zip	:	11201-3610
Country	:	US
Telephone Number	:	718-875-5625
Fax Number	:	718-875-6876

Provider Business Practice Location Address
First Line	:	1420 BUSHWICK AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-1422
Country	:	US
Telephone Number	:	718-453-2277
Fax Number	:	718-453-1489

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	PAMELA STRAKER
Credential	:	PHD
Telephone Number	:	718-875-5625

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	11/16/2007

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