Provider Demographics
NPI:1700117801
Name:MENTAL HEALTH ASSOCIATION OF NASSAU COUNTY
Entity Type:Organization
Organization Name:MENTAL HEALTH ASSOCIATION OF NASSAU COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NEMIROFF
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:516-489-2322
Mailing Address - Street 1:16 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-4020
Mailing Address - Country:US
Mailing Address - Phone:516-489-2322
Mailing Address - Fax:516-489-2784
Practice Address - Street 1:40 TITUS RD
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2229
Practice Address - Country:US
Practice Address - Phone:516-671-1950
Practice Address - Fax:516-671-1974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7232020A320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03154363Medicaid