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General NPI Number Information
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NPI Number | 1386181568
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Entity Type | Organization
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Legal Business Name | NEIGHBORHOOD CHANGE YOUTH ORGANIZATION
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Dates
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Enumeration Date | 01/25/2017
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 88 SENECA ST
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City | STATEN ISLAND
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State | NY
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Zip | 10310-2334
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Country | US
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Telephone | 646-600-1843
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Fax |
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Provider Business Mailing Address
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Address Line | 88 SENECA ST
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City | STATEN ISLAND
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State | NY
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Zip | 10310-2334
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Country | US
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Telephone | 646-600-1843
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | TAKISHA COLLINS
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Credential |
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Telephone | 646-600-1843
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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 | 609775
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 609775
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License Number State | NY
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