Provider Demographics
NPI:1114199486
Name:UNIVERSITY SETTLEMENT
Entity Type:Organization
Organization Name:UNIVERSITY SETTLEMENT
Other - Org Name:VICTORY GUILD CONSULTATION CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHIATRIC SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:212-453-4522
Mailing Address - Street 1:184 ELDRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-2924
Mailing Address - Country:US
Mailing Address - Phone:212-453-4522
Mailing Address - Fax:
Practice Address - Street 1:184 ELDRIDGE ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-2924
Practice Address - Country:US
Practice Address - Phone:212-453-4522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074221251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY074221OtherLMSW