Provider Demographics
NPI:1659351021
Name:LEXINGTON CENTER FOR MENTAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:LEXINGTON CENTER FOR MENTAL HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ADELE
Authorized Official - Middle Name:I
Authorized Official - Last Name:AGIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:718-350-3110
Mailing Address - Street 1:2626 75TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1427
Mailing Address - Country:US
Mailing Address - Phone:718-350-3143
Mailing Address - Fax:718-350-3067
Practice Address - Street 1:2626 75TH ST
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1427
Practice Address - Country:US
Practice Address - Phone:718-350-3143
Practice Address - Fax:718-350-3072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008745-1103TC0700X
NYR018908-011041C0700X
NY073182-011041C0700X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY54609Medicare PIN
NY291184000Medicare UPIN
NY3196861Medicare UPIN
NY350991Medicare UPIN
NYPRIS 13631Medicare UPIN