Provider Demographics
NPI:1811324577
Name:STATEN ISLAND MENTAL HEALTH SOCIETY
Entity type:Organization
Organization Name:STATEN ISLAND MENTAL HEALTH SOCIETY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:FERN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAGOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-442-2225
Mailing Address - Street 1:669 CASTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2028
Mailing Address - Country:US
Mailing Address - Phone:718-442-2225
Mailing Address - Fax:
Practice Address - Street 1:444 SAINT MARKS PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2434
Practice Address - Country:US
Practice Address - Phone:718-720-6727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0896391251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health