Healthcare Provider Details

I. General information

NPI: 1255586459
Provider Name (Legal Business Name): FORDHAM TREMONT COMMUNIYT MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 RYER AVE
BRONX NY
10457-1104
US

IV. Provider business mailing address

4239 BOYD AVE
BRONX NY
10466-2003
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-0617
  • Fax:
Mailing address:
  • Phone: 347-920-4281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberCLINICIAN
License Number StateNY

VIII. Authorized Official

Name: MS. TAMMY F. HOLLAND
Title or Position: CLINICIAN
Credential: MSW
Phone: 347-920-4281