Healthcare Provider Details

I. General information

NPI: 1174557409
Provider Name (Legal Business Name): RIVERDALE MENTAL HEALTH ASSOCIATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5676 RIVERDALE AVENUE
BRONX NY
10471
US

IV. Provider business mailing address

5676 RIVERDALE AVENUE
BRONX NY
10471
US

V. Phone/Fax

Practice location:
  • Phone: 718-796-5300
  • Fax: 718-548-1161
Mailing address:
  • Phone: 718-796-5300
  • Fax: 718-548-1161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number6733100A
License Number StateNY

VIII. Authorized Official

Name: MR. ROBERT M. BREWSTER
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 718-796-5300