Provider Demographics
NPI:1801112131
Name:KINGSBORO PSYCHIATRIC CENTER
Entity type:Organization
Organization Name:KINGSBORO PSYCHIATRIC CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY MENTAL HEALTH NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:R N
Authorized Official - Phone:718-257-7780
Mailing Address - Street 1:681 CLARKSON AVENUE
Mailing Address - Street 2:KINGSBORO PSYCHIATRIC CENTER
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203
Mailing Address - Country:US
Mailing Address - Phone:718-257-8830
Mailing Address - Fax:718-257-8831
Practice Address - Street 1:681 CLARKSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2125
Practice Address - Country:US
Practice Address - Phone:718-257-8830
Practice Address - Fax:718-257-8831
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANARSIE FLATLANDS CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY458461-1283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital