Healthcare Provider Details

I. General information

NPI: 1790410843
Provider Name (Legal Business Name): GREENWICH HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2022
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 MERCER ST
NEW YORK NY
10012-1502
US

IV. Provider business mailing address

190 MERCER ST
NEW YORK NY
10012-1502
US

V. Phone/Fax

Practice location:
  • Phone: 212-677-3400
  • Fax: 212-995-5897
Mailing address:
  • Phone: 212-677-3400
  • Fax: 212-995-5897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHONTEL TENEAN ARNOLD
Title or Position: COUNSELOR
Credential: CASAC
Phone: 212-677-3400