Healthcare Provider Details

I. General information

NPI: 1255706750
Provider Name (Legal Business Name): THE GLBT PROJECT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17843 SELOVER RD
JAMAICA NY
11434-3436
US

IV. Provider business mailing address

17843 SELOVER RD
JAMAICA NY
11434-3436
US

V. Phone/Fax

Practice location:
  • Phone: 347-426-5745
  • Fax: 718-285-7583
Mailing address:
  • Phone: 718-408-0811
  • Fax: 718-285-7583

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 Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

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