Healthcare Provider Details

I. General information

NPI: 1417497421
Provider Name (Legal Business Name): CAMELOT COUNSELING OF STATEN ISLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2017
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4442 ARTHUR KILL ROAD
STATEN ISLAND NY
10309-1304
US

IV. Provider business mailing address

4442 ARTHUR KILL ROAD
STATEN ISLAND NY
10309-1304
US

V. Phone/Fax

Practice location:
  • Phone: 718-356-5100
  • Fax: 718-356-3155
Mailing address:
  • Phone: 718-356-5100
  • Fax: 718-356-3155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. LUKE NASTA
Title or Position: EXECUTIVE DIRECTOR
Credential: CASAC
Phone: 718-356-5100