Healthcare Provider Details

I. General information

NPI: 1588764401
Provider Name (Legal Business Name): TOWN OF BABYLON - DIVISION OF DRUG AND ALCOHOL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 PHELPS LANE
NORTH BABYLON NY
11703
US

IV. Provider business mailing address

281 PHELPS LANE
NORTH BABYLON NY
11703
US

V. Phone/Fax

Practice location:
  • Phone: 631-422-7676
  • Fax: 631-422-7609
Mailing address:
  • Phone: 631-422-7676
  • Fax: 631-422-7609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number170411544
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number070411544
License Number StateNY

VIII. Authorized Official

Name: DELORES AUDREY BOCKLET
Title or Position: DIRECTOR
Credential: LCSW-R, CASAC
Phone: 631-422-7676