Provider Demographics
NPI:1194185363
Name:SISTERS OF THE GOOD SHEPHERD
Entity Type:Organization
Organization Name:SISTERS OF THE GOOD SHEPHERD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACTING PROVINCE LEADER
Authorized Official - Prefix:
Authorized Official - First Name:ROSALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MENARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-278-1155
Mailing Address - Street 1:25-30 21 AVENUE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105
Mailing Address - Country:US
Mailing Address - Phone:718-278-1155
Mailing Address - Fax:718-278-1158
Practice Address - Street 1:25-30 21 AVENUE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105
Practice Address - Country:US
Practice Address - Phone:718-278-1155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty