Provider Demographics
NPI:1740650332
Name:SAMARITAN VILLAGE HARLEM OUTPATIENT
Entity type:Organization
Organization Name:SAMARITAN VILLAGE HARLEM OUTPATIENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASEWORKER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CASAC
Authorized Official - Phone:212-864-4128
Mailing Address - Street 1:55 W 125TH ST
Mailing Address - Street 2:11TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4516
Mailing Address - Country:US
Mailing Address - Phone:212-864-4128
Mailing Address - Fax:212-662-9193
Practice Address - Street 1:55 W 125TH ST
Practice Address - Street 2:11TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4516
Practice Address - Country:US
Practice Address - Phone:212-864-4128
Practice Address - Fax:212-662-9193
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAMARITAN VILLAGE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31027261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health