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General NPI Number Information
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NPI Number | 1194974550
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Entity Type | Organization
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Legal Business Name | CENTER FOR ADDICTION RECOVERY & EMPOWERMENT
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Dates
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Enumeration Date | 09/10/2008
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Last Update Date | 04/08/2015
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Provider Practice Location Address
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Address Line | 2805 VETERANS HIGHWAY SUITES 4 & 5
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City | RONKONKOMA
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State | NY
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Zip | 11779
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Country | US
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Telephone | 631-532-5234
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Fax | 631-608-0688
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Provider Business Mailing Address
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Address Line | 2805 VETERANS HIGHWAY SUITES 4 & 5
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City | RONKONKOMA
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State | NY
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Zip | 11779
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Country | US
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Telephone | 631-532-5234
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Fax | 631-608-0688
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Authorized Official
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Title or Position | OWNER
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Name | MRS. EWA I. LOSKOT-D'SOUZA
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Credential | CASAC
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Telephone | 631-532-5234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 090811664
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License Number State | NY
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