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NPI Code Detail

MEDICARE: THE FORTUNE SOCIETY INC.

MEDICARE: THE FORTUNE SOCIETY INC.
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
1101YA0400XAddiction (Substance Use Disorder) Counselor17241NY
2101YA0400XAddiction (Substance Use Disorder) Counselor061211539NY
3101YA0400XAddiction (Substance Use Disorder) Counselor11776NY
4101YM0800XMental Health Counselor8095001ANY
5101YA0400XAddiction (Substance Use Disorder) Counselor19241NY
6101YA0400XAddiction (Substance Use Disorder) Counselor17947NY
71041C0700XClinical Social Worker0483531NY
8101YA0400XAddiction (Substance Use Disorder) Counselor141011539NY

Other Identifiers

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

General Provider Information

NPI Number : 1235357237
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE FORTUNE SOCIETY INC.
Provider Business Mailing Address
First Line : 29-76 NORTHERN BLVD
Second Line : 2ND FL
City : LONG ISLAND CITY
State : NY
Zip : 11101-2822
Country : US
Telephone Number : 347-510-3442
Fax Number : 347-510-3457
Provider Business Practice Location Address
First Line : THE FORTUNE SOCIETY INC.
Second Line : 29-76 NORTHERN BLVD 2ND FL
City : LONG ISLAND CITY
State : NY
Zip : 11101-2822
Country : US
Telephone Number : 212-691-7554
Fax Number : 347-510-3457
Authorized Official
Title or Position : VP, AGENCY OPERATIONS
Name : SHERRY GOLDSTEIN
Credential :
Telephone Number : 212-691-7554
Provider Enumeration Date : 04/23/2007
Last Update Date : 12/01/2025

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