Provider Demographics
NPI:1821271222
Name:SPANISH SPEAKING EDERLY COUNCIL-RAICES
Entity Type:Organization
Organization Name:SPANISH SPEAKING EDERLY COUNCIL-RAICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOSA-DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-222-1518
Mailing Address - Street 1:410 E 17TH ST APT 4A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-5736
Mailing Address - Country:US
Mailing Address - Phone:917-620-7265
Mailing Address - Fax:
Practice Address - Street 1:10 HANOVER PL PH
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5840
Practice Address - Country:US
Practice Address - Phone:718-222-1518
Practice Address - Fax:718-222-4376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0748751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty