Healthcare Provider Details

I. General information

NPI: 1851534911
Provider Name (Legal Business Name): COMPREHENSIVE SERVICE PROVIDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2009
Last Update Date: 04/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1846 E 23RD ST
BROOKLYN NY
11229-1529
US

IV. Provider business mailing address

1846 E 23RD ST
BROOKLYN NY
11229-1529
US

V. Phone/Fax

Practice location:
  • Phone: 718-344-1745
  • Fax: 212-655-5436
Mailing address:
  • Phone: 718-344-1745
  • Fax: 212-655-5436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberR020090-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberR020090-1
License Number StateNY

VIII. Authorized Official

Name: MS. MALKAH ILOVITZ
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSWR
Phone: 718-344-1745