Provider Demographics
NPI:1124166145
Name:LINCOLN MEDICAL & MENTAL HEATH CENTER
Entity type:Organization
Organization Name:LINCOLN MEDICAL & MENTAL HEATH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEATH COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MS ED
Authorized Official - Phone:718-579-5156
Mailing Address - Street 1:25 NEPTUNE BLVD APT 8R
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4654
Mailing Address - Country:US
Mailing Address - Phone:516-431-4756
Mailing Address - Fax:
Practice Address - Street 1:234 E 149TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5504
Practice Address - Country:US
Practice Address - Phone:718-579-5156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000334282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren