Provider Demographics
NPI:1639393101
Name:COMMUNITY COUNSELING & MEDIATION
Entity Type:Organization
Organization Name:COMMUNITY COUNSELING & MEDIATION
Other - Org Name:TREATMENT ANOTHER PLACE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EMORY
Authorized Official - Middle Name:XAVIER
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-802-0666
Mailing Address - Street 1:115 W 31ST ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3403
Mailing Address - Country:US
Mailing Address - Phone:212-564-6006
Mailing Address - Fax:212-564-3440
Practice Address - Street 1:115 W 31ST ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3403
Practice Address - Country:US
Practice Address - Phone:212-564-6006
Practice Address - Fax:212-564-3440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7655430322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children