Provider Demographics
NPI:1497832919
Name:BEVERLEY MACK HARRY CONSULTING SERVICES INC.
Entity Type:Organization
Organization Name:BEVERLEY MACK HARRY CONSULTING SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWR
Authorized Official - Phone:718-363-0100
Mailing Address - Street 1:PO BOX 250836
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-0836
Mailing Address - Country:US
Mailing Address - Phone:717-363-0100
Mailing Address - Fax:718-363-3005
Practice Address - Street 1:738 CROWN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-5442
Practice Address - Country:US
Practice Address - Phone:718-363-0100
Practice Address - Fax:718-363-3005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8796100A261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01472917Medicaid
NYN85401Medicare ID - Type Unspecified