Provider Demographics
NPI:1528232469
Name:COMMUNITY PARTNERSHIP RESOURCE AND REFERRALS
Entity Type:Organization
Organization Name:COMMUNITY PARTNERSHIP RESOURCE AND REFERRALS
Other - Org Name:COMMUNITY PARTNERSHIP REFERRALS AND RESOURCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:THEOTOKAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:7182-248-8010
Mailing Address - Street 1:25410 NORTHERN BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1415
Mailing Address - Country:US
Mailing Address - Phone:718-224-2010
Mailing Address - Fax:718-225-3366
Practice Address - Street 1:25410 NORTHERN BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-1415
Practice Address - Country:US
Practice Address - Phone:718-224-2010
Practice Address - Fax:718-225-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074639251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health