Provider Demographics
NPI:1578516738
Name:ASSOCIATION FOR MENTAL HEALTH AND WELLNESS INC
Entity Type:Organization
Organization Name:ASSOCIATION FOR MENTAL HEALTH AND WELLNESS INC
Other - Org Name:CLUBHOUSE OF SUFFOLK, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARIANELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-471-7242
Mailing Address - Street 1:939 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-6066
Mailing Address - Country:US
Mailing Address - Phone:631-471-7242
Mailing Address - Fax:631-738-0427
Practice Address - Street 1:939 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-6066
Practice Address - Country:US
Practice Address - Phone:631-471-7242
Practice Address - Fax:631-738-0427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251B00000X
NY8587420A251S00000X
NY8587006A251S00000X
NY8587007A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01367064Medicaid
NY02996261Medicaid
NY02164405Medicaid
NY02871841Medicaid
NY02938489Medicaid
NY02996261Medicaid