MEDICARE: CENTER FOR BEHAVIORAL HEALTH SERVICES, 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	251S00000X	Community/Behavioral Health Agency
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1609263698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR BEHAVIORAL HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	1931 MOTT AVE
Second Line	:	SUITE 317
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-4100
Country	:	US
Telephone Number	:	718-312-3919
Fax Number	:	718-327-2401

Provider Business Practice Location Address
First Line	:	1 SMITH ST
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5111
Country	:	US
Telephone Number	:	718-210-3800
Fax Number	:	718-222-2982

Authorized Official
Title or Position	:	CEO
Name	:	MR. DAVID N WIEDER
Credential	:	JD
Telephone Number	:	718-312-3919

Provider Enumeration Date	:	04/17/2015
Last Update Date	:	04/17/2015

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