Provider Demographics
NPI:1083811681
Name:GATEWAY COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:GATEWAY COUNSELING CENTER, INC.
Other - Org Name:GCC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:V
Authorized Official - Last Name:BAYER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:718-325-5021
Mailing Address - Street 1:4500 FURMAN AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-1602
Mailing Address - Country:US
Mailing Address - Phone:718-325-5021
Mailing Address - Fax:718-324-6845
Practice Address - Street 1:4500 FURMAN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1602
Practice Address - Country:US
Practice Address - Phone:718-325-5021
Practice Address - Fax:718-324-6845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251B00000X, 251C00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01538132Medicaid
NY02693052Medicaid
NY01098360Medicaid
NY01998952Medicaid