Provider Demographics
NPI:1619369048
Name:CATHOLIC CHARITIES BROOKLYN & QUEENS
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES BROOKLYN & QUEENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TEAM SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRITTNEY
Authorized Official - Middle Name:N
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:718-398-0153
Mailing Address - Street 1:25 CHAPEL ST
Mailing Address - Street 2:SUITE 901
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1952
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 CHAPEL ST
Practice Address - Street 2:SUITE 901
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1952
Practice Address - Country:US
Practice Address - Phone:718-398-0153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094063-1302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization