Provider Demographics
NPI:1760627723
Name:BROOKVILLE CENTER FOR CHILDREN'S SERVICES,INC.
Entity Type:Organization
Organization Name:BROOKVILLE CENTER FOR CHILDREN'S SERVICES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:MASCARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-626-1000
Mailing Address - Street 1:189 WHEATLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11545
Mailing Address - Country:US
Mailing Address - Phone:516-626-1000
Mailing Address - Fax:516-622-9494
Practice Address - Street 1:189 WHEATLEY ROAD
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:NY
Practice Address - Zip Code:11545
Practice Address - Country:US
Practice Address - Phone:516-626-1000
Practice Address - Fax:516-626-3308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency