Provider Demographics
NPI:1629172036
Name:HENRY STREET SETTLEMENT
Entity Type:Organization
Organization Name:HENRY STREET SETTLEMENT
Other - Org Name:COMMUNITY CONSULTATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-766-9200
Mailing Address - Street 1:40 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-4808
Mailing Address - Country:US
Mailing Address - Phone:212-233-5032
Mailing Address - Fax:
Practice Address - Street 1:40 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4808
Practice Address - Country:US
Practice Address - Phone:212-233-5032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6700100A261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02843112Medicaid
NYW01951OtherMEDICARE PTAN
NYW01951Medicare ID - Type Unspecified