MEDICARE: COUNSELING SERVICE OF EDNY

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1912327420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNSELING SERVICE OF EDNY

Provider Business Mailing Address
First Line	:	210 JORALEMON ST
Second Line	:	3RD FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11201-3743
Country	:	US
Telephone Number	:	718-250-5557
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 JORALEMON ST
Second Line	:	3RD FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11201-3743
Country	:	US
Telephone Number	:	718-250-5557
Fax Number	:

Authorized Official
Title or Position	:	SUBSTANCE ABUSE THERAPIST
Name	:	MS. LATOYA ALTHEA CHALMERS
Credential	:	MSW
Telephone Number	:	718-250-4824

Provider Enumeration Date	:	04/23/2014
Last Update Date	:	04/23/2014

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