Healthcare Provider Details

I. General information

NPI: 1770954570
Provider Name (Legal Business Name): THE COLLABORATIVE HELP CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 RICHMOND AVE LOWER LEVEL
STATEN ISLAND NY
10312-5633
US

IV. Provider business mailing address

4131 RICHMOND AVE LOWER LEVEL
STATEN ISLAND NY
10312-5633
US

V. Phone/Fax

Practice location:
  • Phone: 347-466-3047
  • Fax:
Mailing address:
  • Phone: 347-466-3047
  • 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 Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY SCOTT STANTON
Title or Position: DIRECTOR
Credential:
Phone: 347-466-3047