Provider Demographics
NPI:1457015331
Name:MOUNTAINSIDE WESTCHESTER LLC
Entity Type:Organization
Organization Name:MOUNTAINSIDE WESTCHESTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-362-5232
Mailing Address - Street 1:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06018-0717
Mailing Address - Country:US
Mailing Address - Phone:860-362-5232
Mailing Address - Fax:877-861-6507
Practice Address - Street 1:243 W 18TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-4569
Practice Address - Country:US
Practice Address - Phone:860-362-5232
Practice Address - Fax:877-861-6507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-26
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management