Provider Demographics
NPI:1356617476
Name:ST. VINCENT'S SERVICES
Entity type:Organization
Organization Name:ST. VINCENT'S SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SLAYBACK
Authorized Official - Suffix:
Authorized Official - Credentials:CASAC
Authorized Official - Phone:718-981-7861
Mailing Address - Street 1:148 BAY ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2503
Mailing Address - Country:US
Mailing Address - Phone:718-981-7861
Mailing Address - Fax:
Practice Address - Street 1:148 BAY ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2503
Practice Address - Country:US
Practice Address - Phone:718-981-7861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1301111022251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health