Provider Demographics
NPI:1821309824
Name:LONG BEACH REACH, INC.
Entity Type:Organization
Organization Name:LONG BEACH REACH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VOLK
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:516-889-2332
Mailing Address - Street 1:2-12 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2025
Mailing Address - Country:US
Mailing Address - Phone:516-889-2332
Mailing Address - Fax:516-889-2399
Practice Address - Street 1:2-12 W PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2025
Practice Address - Country:US
Practice Address - Phone:516-889-2332
Practice Address - Fax:516-889-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080352-1251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health