Provider Demographics
NPI: | 1528554912 |
---|---|
Name: | POSITIVE HEALTH PROJECT, INC. |
Entity Type: | Organization |
Organization Name: | POSITIVE HEALTH PROJECT, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR OF CREDENTIALING |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DEBORA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CARRERO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 718-408-6522 |
Mailing Address - Street 1: | 57 WILLOUGHBY ST FL 2 |
Mailing Address - Street 2: | |
Mailing Address - City: | BROOKLYN |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 11201-5290 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 718-405-6522 |
Mailing Address - Fax: | 718-408-6599 |
Practice Address - Street 1: | 301 W 37TH ST FL 3 |
Practice Address - Street 2: | |
Practice Address - City: | NEW YORK |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10018 |
Practice Address - Country: | US |
Practice Address - Phone: | 212-465-8304 |
Practice Address - Fax: | 718-408-6599 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-07-09 |
Last Update Date: | 2018-07-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Single Specialty |