Healthcare Provider Details

I. General information

NPI: 1174258396
Provider Name (Legal Business Name): ORGANIZATION FOR DEVELOPMENT AND HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9609 SPRINGFIELD BLVD STE 201
QUEENS VILLAGE NY
11429-1360
US

IV. Provider business mailing address

9609 SPRINGFIELD BLVD STE 201
QUEENS VILLAGE NY
11429-1360
US

V. Phone/Fax

Practice location:
  • Phone: 347-838-5433
  • Fax:
Mailing address:
  • Phone: 347-838-5433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CLAIRE CASSEUS
Title or Position: PROGRAM DIRECTOR
Credential: PH.D
Phone: 347-933-2244