MEDICARE: UPPER MANHATTAN MENTAL HEALTH CENTER, 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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	074242-1	NY

General Provider Information

NPI Number	:	1316977176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPPER MANHATTAN MENTAL HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	1727 AMSTERDAM AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-4611
Country	:	US
Telephone Number	:	212-694-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1727 AMSTERDAM AVENUE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-4611
Country	:	US
Telephone Number	:	212-694-9200
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. WILLIAM WITHERSPOON
Credential	:	L.C.S.W.
Telephone Number	:	212-694-9200

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	08/22/2020

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