Provider Demographics
NPI:1336449222
Name:INTERNATIONAL CENTER FOR THE DISABLED
Entity Type:Organization
Organization Name:INTERNATIONAL CENTER FOR THE DISABLED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE ABUSE COUNSELOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:XIOMARA
Authorized Official - Middle Name:AMANDA
Authorized Official - Last Name:MIGLIORINO
Authorized Official - Suffix:
Authorized Official - Credentials:CASAC
Authorized Official - Phone:212-585-6221
Mailing Address - Street 1:237 W 115TH ST
Mailing Address - Street 2:APT 6A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-2900
Mailing Address - Country:US
Mailing Address - Phone:347-500-0017
Mailing Address - Fax:
Practice Address - Street 1:340 E 24TH ST
Practice Address - Street 2:SUITE 311
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4019
Practice Address - Country:US
Practice Address - Phone:212-585-6221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110110619261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder