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General NPI Number Information
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NPI Number | 1689854820
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Entity Type | Organization
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Legal Business Name | LOWER EASTSIDE SERVICE CENTER
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 11/05/2007
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Provider Practice Location Address
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Address Line | 46 E BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10002-6803
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Country | US
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Telephone | 212-343-3565
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Fax |
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Provider Business Mailing Address
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Address Line | 203 STULTS LN
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-5821
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Country | US
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Telephone | 201-978-4985
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MRS. STACEY MICHELLE TROICKI
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Credential | LMSW
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Telephone | 212-343-3565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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