Provider Demographics
NPI:1780858274
Name:NEW CREATION CHRISTIAN COUNSELING & PROFESSIONAL SERVICES
Entity Type:Organization
Organization Name:NEW CREATION CHRISTIAN COUNSELING & PROFESSIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENE
Authorized Official - Middle Name:ALEXIA
Authorized Official - Last Name:SMALLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-795-0009
Mailing Address - Street 1:10 OZONE PL
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6817
Mailing Address - Country:US
Mailing Address - Phone:516-795-0009
Mailing Address - Fax:516-797-8850
Practice Address - Street 1:10 OZONE PL
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6817
Practice Address - Country:US
Practice Address - Phone:516-795-0009
Practice Address - Fax:516-797-8850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR057190101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02385546Medicaid
NY127123OtherVYTRA HEALTH PLANS
NY370673OtherHARMONY BEHAVIORAL HEALTH
747-9139OtherGHI
NYN90706OtherHEALTH NET
NYP1020668OtherOXFORD
NYR057190-A37OtherHEALTH FIRST
NY269983OtherMHN
NY413031OtherVALUE OPTIONS
NY7797384OtherAETNA
NYIP573503OtherMAGELLAN
NYN5V961OtherEMPIRE BC/BS
NY057190-N01OtherHIP
NY6238574OtherUBH
NY000530050201OtherHEALTH PLUS
NY1826607OtherCIGNA
NY6238574OtherUBH
NYN90706OtherHEALTH NET
NY6238574OtherUBH
NY02385546Medicaid