Provider Demographics
NPI:1750444188
Name:UNIVERSITY CONSULTATION AND TREATMENT CENTER FOR MENTAL HYGIENE, INC
Entity Type:Organization
Organization Name:UNIVERSITY CONSULTATION AND TREATMENT CENTER FOR MENTAL HYGIENE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:718-293-8400
Mailing Address - Street 1:1020 GRAND CONCOURSE
Mailing Address - Street 2:SUITE 26
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-2605
Mailing Address - Country:US
Mailing Address - Phone:718-293-8400
Mailing Address - Fax:718-293-1461
Practice Address - Street 1:1020 GRAND CONCOURSE
Practice Address - Street 2:SUITE 26
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-2605
Practice Address - Country:US
Practice Address - Phone:718-293-8400
Practice Address - Fax:718-293-1461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244775Medicaid
NY01305077Medicaid
NY02187268Medicaid
NY00244775Medicaid