Healthcare Provider Details

I. General information

NPI: 1083811681
Provider Name (Legal Business Name): GATEWAY COUNSELING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 FURMAN AVE
BRONX NY
10470-1602
US

IV. Provider business mailing address

4500 FURMAN AVE
BRONX NY
10470-1602
US

V. Phone/Fax

Practice location:
  • Phone: 718-325-5021
  • Fax: 718-324-6845
Mailing address:
  • Phone: 718-325-5021
  • Fax: 718-324-6845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNY

VIII. Authorized Official

Name: MR. SHAWN V BAYER
Title or Position: EXECUTIVE DIRECTOR
Credential: LMSW
Phone: 718-325-5021