Healthcare Provider Details

I. General information

NPI: 1801112131
Provider Name (Legal Business Name): KINGSBORO PSYCHIATRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 CLARKSON AVE
BROOKLYN NY
11203-2125
US

IV. Provider business mailing address

681 CLARKSON AVENUE KINGSBORO PSYCHIATRIC CENTER
BROOKLYN NY
11203
US

V. Phone/Fax

Practice location:
  • Phone: 718-257-8830
  • Fax: 718-257-8831
Mailing address:
  • Phone: 718-257-8830
  • Fax: 718-257-8831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number458461-1
License Number StateNY

VIII. Authorized Official

Name: MRS. VERONICA JOHNSON
Title or Position: COMMUNITY MENTAL HEALTH NURSE
Credential: R N
Phone: 718-257-7780