Provider Demographics
NPI:1255586459
Name:FORDHAM TREMONT COMMUNIYT MENTAL HEALTH CENTER
Entity type:Organization
Organization Name:FORDHAM TREMONT COMMUNIYT MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:F
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:347-920-4281
Mailing Address - Street 1:4239 BOYD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2003
Mailing Address - Country:US
Mailing Address - Phone:347-920-4281
Mailing Address - Fax:
Practice Address - Street 1:2250 RYER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-1104
Practice Address - Country:US
Practice Address - Phone:718-960-0617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCLINICIAN283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCLINICIANMedicaid
NYCLINICIANMedicaid