Provider Demographics
NPI:1346505799
Name:THIS TOO SHALL PAST
Entity Type:Organization
Organization Name:THIS TOO SHALL PAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MAC, NCAC1, RAS
Authorized Official - Phone:718-918-1716
Mailing Address - Street 1:1530 OVERING ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3106
Mailing Address - Country:US
Mailing Address - Phone:917-975-9731
Mailing Address - Fax:
Practice Address - Street 1:1530 OVERING ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3106
Practice Address - Country:US
Practice Address - Phone:917-975-9731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2180101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty