Healthcare Provider Details

I. General information

NPI: 1174987903
Provider Name (Legal Business Name): THE GLBT PROJECT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165100 BAISLEY BLVD BOX 340990
JAMAICA NY
11434-6374
US

IV. Provider business mailing address

PO BOX 340990
JAMAICA NY
11434-7990
US

V. Phone/Fax

Practice location:
  • Phone: 917-328-6399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: CLAUDETTE BRYANT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 347-426-5745