Provider Demographics
NPI:1619104239
Name:COUNSELING SERVICE EDNY
Entity Type:Organization
Organization Name:COUNSELING SERVICE EDNY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:718-250-4833
Mailing Address - Street 1:16318 JAMAICA AVE
Mailing Address - Street 2:COUNSELING SERVICE OF EDNY
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4901
Mailing Address - Country:US
Mailing Address - Phone:718-658-0010
Mailing Address - Fax:718-658-2962
Practice Address - Street 1:16318 JAMAICA AVE
Practice Address - Street 2:COUNSELING SERVICE OF EDNY
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4901
Practice Address - Country:US
Practice Address - Phone:718-658-0010
Practice Address - Fax:718-658-2962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72079127251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health