MEDICARE: DYNAMIC YOUTH COMMUNITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	C070611509	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225239627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC YOUTH COMMUNITY

Provider Business Mailing Address
First Line	:	1830 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6502
Country	:	US
Telephone Number	:	718-998-5862
Fax Number	:

Provider Business Practice Location Address
First Line	:	1830 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6502
Country	:	US
Telephone Number	:	718-998-5862
Fax Number	:

Authorized Official
Title or Position	:	ASSOCIATE DIRECTOR
Name	:	MS. KAREN CARLINI
Credential	:	CASAC
Telephone Number	:	718-998-5862

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	05/07/2015

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Directions to “DYNAMIC YOUTH COMMUNITY ” Practice Location

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