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General NPI Number Information
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NPI Number | 1588764401
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Entity Type | Organization
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Legal Business Name | TOWN OF BABYLON - DIVISION OF DRUG AND ALCOHOL SERVICES
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 05/04/2015
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Provider Practice Location Address
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Address Line | 281 PHELPS LANE
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City | NORTH BABYLON
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State | NY
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Zip | 11703
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Country | US
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Telephone | 631-422-7676
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Fax | 631-422-7609
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Provider Business Mailing Address
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Address Line | 281 PHELPS LANE
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City | NORTH BABYLON
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State | NY
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Zip | 11703
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Country | US
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Telephone | 631-422-7676
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Fax | 631-422-7609
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Authorized Official
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Title or Position | DIRECTOR
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Name | DELORES AUDREY BOCKLET
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Credential | LCSW-R, CASAC
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Telephone | 631-422-7676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 070411544
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License Number State | NY
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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 | 170411544
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License Number State | NY
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