Healthcare Provider Details

I. General information

NPI: 1831267483
Provider Name (Legal Business Name): UPPER MANAHTTAN MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215-217 WEST 135TH ST
NEW YORK NY
10030
US

IV. Provider business mailing address

86 W 119TH ST
NEW YORK NY
10026-1426
US

V. Phone/Fax

Practice location:
  • Phone: 212-694-3500
  • Fax:
Mailing address:
  • Phone: 212-410-6519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL HARGROW
Title or Position: PROGRAM DIRECTOR
Credential: LCSW
Phone: 212-694-3500