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General NPI Number Information
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NPI Number | 1588817407
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Entity Type | Organization
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Legal Business Name | ST GREGORY THE GREAT COMMUNITY SERVICE CENTER INC
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Dates
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Enumeration Date | 10/23/2008
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Last Update Date | 12/18/2008
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Provider Practice Location Address
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Address Line | 8819 CROSS ISLAND PKWY
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City | BELLEROSE
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State | NY
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Zip | 11426-1633
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Country | US
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Telephone | 718-343-5978
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Fax | 718-343-4101
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Provider Business Mailing Address
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Address Line | 8819 CROSS ISLAND PKWY
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City | BELLEROSE
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State | NY
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Zip | 11426-1633
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Country | US
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Telephone | 718-343-5978
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Fax | 718-343-4101
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. MARIANNE FARELLA
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Credential | LCSW-R
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Telephone | 718-343-5978
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R048675-1
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License Number State | NY
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