Healthcare Provider Details

I. General information

NPI: 1962551143
Provider Name (Legal Business Name): THE CHILD CENTER OF NY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 12/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8114 QUEENS BLVD
ELMHURST NY
11373-3789
US

IV. Provider business mailing address

6002 QUEENS BLVD LOWER LEVEL
WOODSIDE NY
11377-4973
US

V. Phone/Fax

Practice location:
  • Phone: 718-899-9810
  • Fax: 718-899-9699
Mailing address:
  • Phone: 718-651-7770
  • Fax: 718-651-5029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JEAN M COPPOLA
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 718-651-7770