Provider Demographics
NPI:1457649170
Name:COMMUNITY MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:COMMUNITY MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-869-8822
Mailing Address - Street 1:138 CAYUGA AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11509-1221
Mailing Address - Country:US
Mailing Address - Phone:516-239-5222
Mailing Address - Fax:
Practice Address - Street 1:521 BEACH 20TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-3645
Practice Address - Country:US
Practice Address - Phone:718-869-8822
Practice Address - Fax:718-869-8829
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. JOHN'S EPISCOPAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078780251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health