Provider Demographics
NPI:1669654794
Name:LONG BEACH MEDICAL CENTER - COUNSELING MENTAL HEALTH
Entity Type:Organization
Organization Name:LONG BEACH MEDICAL CENTER - COUNSELING MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:516-897-1212
Mailing Address - Street 1:455 E BAY DR
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2301
Mailing Address - Country:US
Mailing Address - Phone:516-897-1065
Mailing Address - Fax:516-897-1064
Practice Address - Street 1:455 E BAY DR
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2301
Practice Address - Country:US
Practice Address - Phone:516-897-1065
Practice Address - Fax:516-897-1064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02604240Medicaid