=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629593892
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANTOINETTE CAVALENES JOYCE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2017
-----------------------------------------------------
Last Update Date | 04/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 290 GARRETSON AVE
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10305-1236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-698-3222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 COLONIAL CT
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10310-2806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-442-2394
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANTOINETTE CAVALENES JOYCE
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 718-698-3222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number | R036109-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------