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General NPI Number Information
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NPI Number | 1912280389
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Entity Type | Organization
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Legal Business Name | AREBA CASRIEL INC
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Dates
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Enumeration Date | 09/22/2011
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Last Update Date | 09/22/2011
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Provider Practice Location Address
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Address Line | 315 5TH AVE
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City | NEW YORK
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State | NY
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Zip | 10016-6510
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Country | US
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Telephone | 212-378-4545
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Fax |
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Provider Business Mailing Address
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Address Line | 315 5TH AVE
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City | NEW YORK
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State | NY
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Zip | 10016-6510
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Country | US
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Telephone | 212-378-4545
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. SELWYN FERGUS
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Credential | LCSW
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Telephone | 212-378-4545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 133113707
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License Number State | NY
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