=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144536640
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARENTS IN ACTION FOR LEADERSHIP AND HUMAN RIGHTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2010
-----------------------------------------------------
Last Update Date | 08/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3753 90TH ST 2ND FLOOR
-----------------------------------------------------
City | JACKSON HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11372-7873
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-713-6488
-----------------------------------------------------
Fax | 718-713-2302
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3753 90TH ST 2ND FLOOR
-----------------------------------------------------
City | JACKSON HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11372-7873
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-713-6488
-----------------------------------------------------
Fax | 718-713-2302
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. ROLANDO A BINI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-713-6488
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 068951
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 068951
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 068951
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 068951
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 068951
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------