Provider Demographics
NPI:1831644657
Name:SERVICE PROGRAM FOR OLDER PEOPLE
Entity type:Organization
Organization Name:SERVICE PROGRAM FOR OLDER PEOPLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DONATO
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL BENE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:212-787-7120
Mailing Address - Street 1:302 W 91ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1011
Mailing Address - Country:US
Mailing Address - Phone:212-787-7120
Mailing Address - Fax:
Practice Address - Street 1:302 W 91ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1011
Practice Address - Country:US
Practice Address - Phone:212-787-7120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073466251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health