Provider Demographics
NPI:1669668224
Name:LESBIAN AND GAY COMMUNITY SERVICES CENTER, INC.
Entity Type:Organization
Organization Name:LESBIAN AND GAY COMMUNITY SERVICES CENTER, INC.
Other - Org Name:LESBIAN, GAY, BISEXUAL AND TRANSGENDER COMMUNITY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF ADULT SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBERTO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MS, LCSW-R, CASAC
Authorized Official - Phone:646-556-9296
Mailing Address - Street 1:208 W 13TH ST.
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011
Mailing Address - Country:US
Mailing Address - Phone:646-556-9300
Mailing Address - Fax:646-486-9381
Practice Address - Street 1:208 W 13TH ST.
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:646-556-9300
Practice Address - Fax:646-486-9381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080711628251S00000X
NY078203251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02911035Medicaid