Provider Demographics
NPI:1760917603
Name:FLATBUSH TREATMENT ADDICTION CENTER
Entity Type:Organization
Organization Name:FLATBUSH TREATMENT ADDICTION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE WORKER
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:A
Authorized Official - Last Name:KISSOON
Authorized Official - Suffix:
Authorized Official - Credentials:CASAC-T
Authorized Official - Phone:646-467-0556
Mailing Address - Street 1:595 CONEY ISLAND AVE
Mailing Address - Street 2:2A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-4374
Mailing Address - Country:US
Mailing Address - Phone:646-467-0556
Mailing Address - Fax:
Practice Address - Street 1:595 CONEY ISLAND AVE
Practice Address - Street 2:2A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-4374
Practice Address - Country:US
Practice Address - Phone:646-467-0556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC CHARITIES NEIGHBORHOOD SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health