Provider Demographics
NPI:1184337404
Name:EMMAS PLACE-STATEN ISLAND GRIEF AND LOSS CENTER FOR CHILDREN AND FAMIL
Entity type:Organization
Organization Name:EMMAS PLACE-STATEN ISLAND GRIEF AND LOSS CENTER FOR CHILDREN AND FAMIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:KIEFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-453-9690
Mailing Address - Street 1:PO BOX 10311
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-0311
Mailing Address - Country:US
Mailing Address - Phone:845-453-9690
Mailing Address - Fax:
Practice Address - Street 1:1000 RICHMOND TER # D
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-1114
Practice Address - Country:US
Practice Address - Phone:347-850-2322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health