Provider Demographics
NPI:1922180363
Name:SOUTH BEACH ADDICTION TREATMENT CENTER
Entity Type:Organization
Organization Name:SOUTH BEACH ADDICTION TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE COMMISIONER DIVISION OF
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-457-5312
Mailing Address - Street 1:777 SEAVIEW AVENUE
Mailing Address - Street 2:BUILDING A SOUTH BEACH PSYCHIATRIC CENTER
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3499
Mailing Address - Country:US
Mailing Address - Phone:718-667-5202
Mailing Address - Fax:718-351-1958
Practice Address - Street 1:777 SEAVIEW AVENUE
Practice Address - Street 2:BUILDING A SOUTH BEACH PSYCHIATRIC CENTER
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3499
Practice Address - Country:US
Practice Address - Phone:718-667-5202
Practice Address - Fax:718-351-1958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01421636Medicaid