MEDICARE: GLENCARA, 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	251V00000X	Voluntary or Charitable Agency	15623	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1215001	OTHER	NY	PSYCHOTHERAPY

General Provider Information

NPI Number	:	1689654782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENCARA, INC

Provider Business Mailing Address
First Line	:	8605 218TH ST
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11427-1922
Country	:	US
Telephone Number	:	718-454-9804
Fax Number	:	718-454-9806

Provider Business Practice Location Address
First Line	:	8605 218TH ST
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11427-1922
Country	:	US
Telephone Number	:	718-454-9804
Fax Number	:	718-454-9806

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SEAN FOLEY
Credential	:	LCSW
Telephone Number	:	718-454-9804

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	09/17/2015

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