Provider Demographics
NPI:1508929621
Name:NORTH SHORE CHILD AND FAMILY GUIDANCE ASSOCIATION INCORPORATED
Entity Type:Organization
Organization Name:NORTH SHORE CHILD AND FAMILY GUIDANCE ASSOCIATION INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MALEKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:516-626-1971
Mailing Address - Street 1:480 OLD WESTBURY ROAD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577
Mailing Address - Country:US
Mailing Address - Phone:516-626-1971
Mailing Address - Fax:516-625-5647
Practice Address - Street 1:480 OLD WESTBURY ROAD
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577
Practice Address - Country:US
Practice Address - Phone:516-626-1971
Practice Address - Fax:516-625-5647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6795122A261QM0855X
NY6795120A261QM0855X
NY6795123A261QM0855X
NY080211497261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02995935Medicaid