MEDICARE: NORTH CROWN HEIGHTS FAMILY OUTREACH 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	050411459	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	:	1558419762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH CROWN HEIGHTS FAMILY OUTREACH CENTER INC

Provider Business Mailing Address
First Line	:	765 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216-4203
Country	:	US
Telephone Number	:	718-398-8700
Fax Number	:	718-398-5770

Provider Business Practice Location Address
First Line	:	765 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216-4203
Country	:	US
Telephone Number	:	718-398-8700
Fax Number	:	718-398-5770

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	BERTHOLET DESIR
Credential	:	MD
Telephone Number	:	718-398-8700

Provider Enumeration Date	:	01/07/2007
Last Update Date	:	12/27/2024

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