Provider Demographics
NPI:1023280708
Name:SI BEHAVIORAL NETWORK, INC.
Entity type:Organization
Organization Name:SI BEHAVIORAL NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ARLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-351-5530
Mailing Address - Street 1:4434 AMBOY ROAD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312
Mailing Address - Country:US
Mailing Address - Phone:718-351-5530
Mailing Address - Fax:718-356-2068
Practice Address - Street 1:4434 AMBOY ROAD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312
Practice Address - Country:US
Practice Address - Phone:718-351-5530
Practice Address - Fax:718-356-2068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02187213Medicaid