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NPI Code Detail

MEDICARE: CANARSIE AWARE

MEDICARE: CANARSIE AWARE
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
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/CenterC09110554NY

General Provider Information

NPI Number : 1497971741
Entity Type Code : Organization
Provider Name (Legal Business Name) : CANARSIE AWARE
Provider Business Mailing Address
First Line : 1285 ROCKAWAY AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11236-2330
Country : US
Telephone Number : 718-257-3195
Fax Number : 718-257-5560
Provider Business Practice Location Address
First Line : 1285 ROCKAWAY AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11236-2330
Country : US
Telephone Number : 718-257-3195
Fax Number : 718-257-5560
Authorized Official
Title or Position : BILLING MANAGER
Name : MRS. JACQUELINE PEREZ
Credential :
Telephone Number : 718-585-9366
Provider Enumeration Date : 04/17/2007
Last Update Date : 08/22/2020

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1295064145 — MR. YOHANCE NNAMDI MENDEZ LMSW
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1497066021 — MS. STELLA JOAN PADNOS LMSW
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1922310903 — MR. ANTHONY TSHERING LMSW
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Directions to “CANARSIE AWARE ” Practice Location

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