Provider Demographics
NPI:1629137641
Name:BROOKLYN BUREAU OF COMMUNITY SERVICE
Entity Type:Organization
Organization Name:BROOKLYN BUREAU OF COMMUNITY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR ADULT REHABILITATION SERVI
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA CAS
Authorized Official - Phone:718-310-5630
Mailing Address - Street 1:285 SCHERMERHORN STREET
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1024
Mailing Address - Country:US
Mailing Address - Phone:718-310-5633
Mailing Address - Fax:718-858-2967
Practice Address - Street 1:285 SCHERMERHORN STREET
Practice Address - Street 2:7TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1024
Practice Address - Country:US
Practice Address - Phone:718-310-5633
Practice Address - Fax:718-858-2967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7958001A101YM0800X
NY7958002A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01525566Medicaid