Provider Demographics
NPI:1568546232
Name:FAMILY AND CHILDREN'S ASSOCIATION
Entity Type:Organization
Organization Name:FAMILY AND CHILDREN'S ASSOCIATION
Other - Org Name:LONG ISLAND COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:VASSALLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-746-0350
Mailing Address - Street 1:100 E OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4614
Mailing Address - Country:US
Mailing Address - Phone:516-746-0350
Mailing Address - Fax:516-877-1305
Practice Address - Street 1:510 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 202-204
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-1147
Practice Address - Country:US
Practice Address - Phone:516-437-6050
Practice Address - Fax:516-437-6304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9206007A261QM0801X
NY080410636261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01666971Medicaid
NY01666971Medicaid