Healthcare Provider Details

I. General information

NPI: 1629376793
Provider Name (Legal Business Name): BROOKLYN BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2011
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 MONTROSE AVE
BROOKLYN NY
11206-2722
US

IV. Provider business mailing address

228 MONTROSE AVE
BROOKLYN NY
11206-2722
US

V. Phone/Fax

Practice location:
  • Phone: 718-456-5200
  • Fax:
Mailing address:
  • Phone: 718-456-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number232898
License Number StateNY

VIII. Authorized Official

Name: DR. MODDY H KILUVIA
Title or Position: M.D.
Credential: M.D.
Phone: 718-456-5200