Provider Demographics
NPI:1265581862
Name:LONG BEACH PUBLIC SCHOOLS
Entity type:Organization
Organization Name:LONG BEACH PUBLIC SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PUPIL SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:TATEM
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:516-897-2200
Mailing Address - Street 1:601 LINDELL BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-1736
Mailing Address - Country:US
Mailing Address - Phone:516-897-2200
Mailing Address - Fax:516-897-2208
Practice Address - Street 1:601 LINDELL BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-1736
Practice Address - Country:US
Practice Address - Phone:516-897-2200
Practice Address - Fax:516-897-2208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01377655Medicaid