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NPI Code Detail

MEDICARE: LEXINGTON CENTER FOR MENTAL HEALTH SERVICES, INC.

MEDICARE: LEXINGTON CENTER FOR MENTAL 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
1103TC0700XClinical Psychologist008745-1NY
21041C0700XClinical Social WorkerR018908-01NY
31041C0700XClinical Social Worker073182-01NY
4261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1659351021
Entity Type Code : Organization
Provider Name (Legal Business Name) : LEXINGTON CENTER FOR MENTAL HEALTH SERVICES, INC.
Provider Business Mailing Address
First Line : 2626 75TH ST
Second Line :
City : EAST ELMHURST
State : NY
Zip : 11370-1427
Country : US
Telephone Number : 718-350-3143
Fax Number : 718-350-3067
Provider Business Practice Location Address
First Line : 2626 75TH ST
Second Line :
City : EAST ELMHURST
State : NY
Zip : 11370-1427
Country : US
Telephone Number : 718-350-3143
Fax Number : 718-350-3072
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MS. ADELE I AGIN
Credential : LCSW
Telephone Number : 718-350-3110
Provider Enumeration Date : 01/20/2006
Last Update Date : 06/25/2020

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