Provider Demographics
NPI:1437352184
Name:WOODHULL MEDICAL & MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:WOODHULL MEDICAL & MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY-ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT-MANN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:718-963-5887
Mailing Address - Street 1:24 PAERDEGAT 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4120
Mailing Address - Country:US
Mailing Address - Phone:347-371-9190
Mailing Address - Fax:
Practice Address - Street 1:24 PAERDEGAT 12TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4120
Practice Address - Country:US
Practice Address - Phone:347-371-9190
Practice Address - Fax:718-630-3138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP49687282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY297531Medicare ID - Type Unspecified