Healthcare Provider Details

I. General information

NPI: 1659351021
Provider Name (Legal Business Name): LEXINGTON CENTER FOR MENTAL HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 75TH ST
EAST ELMHURST NY
11370-1427
US

IV. Provider business mailing address

2626 75TH ST
EAST ELMHURST NY
11370-1427
US

V. Phone/Fax

Practice location:
  • Phone: 718-350-3143
  • Fax: 718-350-3072
Mailing address:
  • Phone: 718-350-3143
  • Fax: 718-350-3067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number008745-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR018908-01
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number073182-01
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. ADELE I AGIN
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 718-350-3110