Healthcare Provider Details

I. General information

NPI: 1316104011
Provider Name (Legal Business Name): SAFE SPACE NYC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1931 MOTT AVE 4TH FLOOR
FAR ROCKAWAY NY
11691-4103
US

IV. Provider business mailing address

295 LAFAYETTE ST SUITE 920
NEW YORK NY
10012-2701
US

V. Phone/Fax

Practice location:
  • Phone: 718-471-6818
  • Fax: 718-337-2750
Mailing address:
  • Phone: 212-226-3536
  • Fax: 212-226-1918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7055120B
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7055120B
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number7055120B
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number7055120B
License Number StateNY

VIII. Authorized Official

Name: MS. NAHIDA ABUHAMDA
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 212-226-3536