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General NPI Number Information
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NPI Number | 1588169247
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Entity Type | Organization
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Legal Business Name | THE CLEAN SLATE PROJECT INC.
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 03/26/2018
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Provider Practice Location Address
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Address Line | 888 E 59TH ST
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City | BROOKLYN
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State | NY
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Zip | 11234-1804
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Country | US
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Telephone | 347-304-4505
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Fax |
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Provider Business Mailing Address
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Address Line | 742 E 10TH ST
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City | BROOKLYN
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State | NY
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Zip | 11230-2302
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Country | US
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Telephone | 347-304-4505
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES PRICE
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Credential |
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Telephone | 347-304-4505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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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 |
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State | NY
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