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General NPI Number Information
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NPI Number | 1457015331
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Entity Type | Organization
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Legal Business Name | MOUNTAINSIDE WESTCHESTER LLC
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Dates
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Enumeration Date | 10/26/2021
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Last Update Date | 03/25/2022
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Provider Practice Location Address
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Address Line | 243 W 18TH ST
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City | NEW YORK
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State | NY
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Zip | 10011-4569
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Country | US
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Telephone | 860-362-5232
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Fax | 877-861-6507
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Provider Business Mailing Address
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Address Line | PO BOX 717
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City | CANAAN
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State | CT
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Zip | 06018-0717
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Country | US
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Telephone | 860-362-5232
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Fax | 877-861-6507
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Authorized Official
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Title or Position | DIRECTOR
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Name | MICHELLE WILLIAMSON
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Credential |
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Telephone | 860-362-5232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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