MEDICARE: THE CENTER FOR TRANSFORMATIVE GRIEF JUSTICE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251X00000X	Supports Brokerage Agency
3	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1780529867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CENTER FOR TRANSFORMATIVE GRIEF JUSTICE, INC.

Provider Business Mailing Address
First Line	:	135 MERIDIAN BLVD FL 1
Second Line	:
City	:	ARVERNE
State	:	NY
Zip	:	11692-2021
Country	:	US
Telephone Number	:	718-318-3514
Fax Number	:

Provider Business Practice Location Address
First Line	:	135 MERIDIAN BLVD FL 1
Second Line	:
City	:	ARVERNE
State	:	NY
Zip	:	11692-2021
Country	:	US
Telephone Number	:	718-318-3514
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	LATINA WHITE
Credential	:
Telephone Number	:	347-631-7654

Provider Enumeration Date	:	04/23/2026
Last Update Date	:	04/23/2026

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