Provider Demographics
NPI:1013083476
Name:YMCA OF GREATER NEW YORK
Entity Type:Organization
Organization Name:YMCA OF GREATER NEW YORK
Other - Org Name:STATEN ISLAND YMCA COUNSELING SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:INTERIM EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:VERHEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW,CASAC
Authorized Official - Phone:718-948-3232
Mailing Address - Street 1:3911 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-5110
Mailing Address - Country:US
Mailing Address - Phone:718-948-3232
Mailing Address - Fax:718-966-6605
Practice Address - Street 1:3911 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-5110
Practice Address - Country:US
Practice Address - Phone:718-948-3232
Practice Address - Fax:718-966-6605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY142974OtherVALUE OPTIONS - INSURANCE
NY01992814Medicaid
NY264705OtherCOMPSYCH - INSURANCE
NY1059540OtherBEACON HEALTH STRATEGIES
NYA3385556OtherOXFORD - INSURANCE