Provider Demographics
NPI:1588817407
Name:ST GREGORY THE GREAT COMMUNITY SERVICE CENTER INC
Entity Type:Organization
Organization Name:ST GREGORY THE GREAT COMMUNITY SERVICE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:718-343-5978
Mailing Address - Street 1:8819 CROSS ISLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE
Mailing Address - State:NY
Mailing Address - Zip Code:11426-1633
Mailing Address - Country:US
Mailing Address - Phone:718-343-5978
Mailing Address - Fax:718-343-4101
Practice Address - Street 1:8819 CROSS ISLAND PKWY
Practice Address - Street 2:
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-1633
Practice Address - Country:US
Practice Address - Phone:718-343-5978
Practice Address - Fax:718-343-4101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR048675-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty