Provider Demographics
NPI:1801979604
Name:ST. JOHN'S EPISCOPAL HOSPITAL COMMUNITY MENTAL HEALTH
Entity type:Organization
Organization Name:ST. JOHN'S EPISCOPAL HOSPITAL COMMUNITY MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VIARD-ALOUIDOR
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:718-869-8822
Mailing Address - Street 1:610 GRASSMERE TERRACE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11694
Mailing Address - Country:US
Mailing Address - Phone:718-327-2925
Mailing Address - Fax:718-327-2925
Practice Address - Street 1:521 BEACH 20TH STREET
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691
Practice Address - Country:US
Practice Address - Phone:718-869-8822
Practice Address - Fax:718-869-8829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068466-1251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health