Provider Demographics
NPI:1235357237
Name:THE FORTUNE SOCIETY INC.
Entity Type:Organization
Organization Name:THE FORTUNE SOCIETY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-691-7554
Mailing Address - Street 1:29-76 NORTHERN BLVD
Mailing Address - Street 2:THE FORTUNE SOCIETY INC
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-2822
Mailing Address - Country:US
Mailing Address - Phone:212-691-7554
Mailing Address - Fax:347-510-3457
Practice Address - Street 1:29-76 NORTHERN BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-2822
Practice Address - Country:US
Practice Address - Phone:212-691-7554
Practice Address - Fax:347-510-3457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061211539101YA0400X
NY17947101YA0400X
NY17241101YA0400X
NY11776101YA0400X
NY19241101YA0400X
NY141011539101YA0400X
NY8095001A101YM0800X
NY04835311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02740141Medicaid
NYG100065545Medicare PIN
NYG100065545Medicare UPIN
NY02740141Medicaid