Provider Demographics
NPI:1700938024
Name:LINCOLN MEDICAL & MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:LINCOLN MEDICAL & MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORK SUPERVISOR II
Authorized Official - Prefix:MR
Authorized Official - First Name:EDELMIRO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:718-579-5657
Mailing Address - Street 1:4510 KISSENA BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3431
Mailing Address - Country:US
Mailing Address - Phone:718-661-2636
Mailing Address - Fax:
Practice Address - Street 1:4510 KISSENA BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3431
Practice Address - Country:US
Practice Address - Phone:718-661-2636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYO349041OtherSOCIAL WORK