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General NPI Number Information
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NPI Number | 1790995173
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Entity Type | Organization
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Legal Business Name | BLANTON PEALE COMMUNITY COUNSELING CENTERS
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | FIRST UNITARIAN CHURCH 50 MONROE PLACE
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City | BROOKLYN
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State | NY
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Zip | 11201
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Country | US
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Telephone | 718-253-9001
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Fax |
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Provider Business Mailing Address
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Address Line | 949 W END AVE APT 10F
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City | NEW YORK
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State | NY
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Zip | 10025-3586
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Country | US
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Telephone | 212-662-8986
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. PAMELA PATER ENNIS
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Credential | M.DIV., LCSW
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Telephone | 718-253-9001
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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 | 000677
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License Number State | NY
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