Provider Demographics
NPI:1043562705
Name:PARK SLOPE CREATIVE CENTER
Entity Type:Organization
Organization Name:PARK SLOPE CREATIVE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARYGRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERBERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:ATR-BC, LCSW, LCAT
Authorized Official - Phone:917-941-2652
Mailing Address - Street 1:20 KINGS MILL RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-8902
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:355 5TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-2806
Practice Address - Country:US
Practice Address - Phone:917-941-2652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0746661041C0700X
NY000302221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty