Provider Demographics
NPI:1043504723
Name:ADVISORY COUNCIL FOR THE YOUTH OF MINEOLA, INC.
Entity Type:Organization
Organization Name:ADVISORY COUNCIL FOR THE YOUTH OF MINEOLA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BALBO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:516-742-1715
Mailing Address - Street 1:450 JERICHO TPKE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-1135
Mailing Address - Country:US
Mailing Address - Phone:516-742-1715
Mailing Address - Fax:516-747-5690
Practice Address - Street 1:450 JERICHO TPKE
Practice Address - Street 2:SUITE 207
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-1135
Practice Address - Country:US
Practice Address - Phone:516-742-1715
Practice Address - Fax:516-747-5690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health