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General NPI Number Information
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NPI Number | 1184337404
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Entity Type | Organization
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Legal Business Name | EMMAS PLACE-STATEN ISLAND GRIEF AND LOSS CENTER FOR CHILDREN AND FAMIL
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Dates
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Enumeration Date | 01/02/2023
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Last Update Date | 01/02/2023
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Provider Practice Location Address
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Address Line | 1000 RICHMOND TER # D
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City | STATEN ISLAND
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State | NY
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Zip | 10301-1114
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Country | US
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Telephone | 347-850-2322
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10311
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City | STATEN ISLAND
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State | NY
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Zip | 10301-0311
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Country | US
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Telephone | 845-453-9690
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Fax |
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Authorized Official
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Title or Position | BOARD SECRETARY
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Name | MR. MATTHEW RAYMOND KIEFER
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Credential |
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Telephone | 845-453-9690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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