Provider Demographics
NPI:1629376793
Name:BROOKLYN BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:BROOKLYN BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:MODDY
Authorized Official - Middle Name:H
Authorized Official - Last Name:KILUVIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-456-5200
Mailing Address - Street 1:228 MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-2722
Mailing Address - Country:US
Mailing Address - Phone:718-456-5200
Mailing Address - Fax:
Practice Address - Street 1:228 MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-2722
Practice Address - Country:US
Practice Address - Phone:718-456-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232898103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Single Specialty