Provider Demographics
NPI:1912180316
Name:SPANISH SPEAKING ELDERLY COUNCIL- RAICES
Entity Type:Organization
Organization Name:SPANISH SPEAKING ELDERLY COUNCIL- RAICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOSA-DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:718-222-1518
Mailing Address - Street 1:51 TULIP ST
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-3816
Mailing Address - Country:US
Mailing Address - Phone:201-338-2053
Mailing Address - Fax:718-222-4376
Practice Address - Street 1:10 HANOVER PL PH
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5840
Practice Address - Country:US
Practice Address - Phone:718-222-1518
Practice Address - Fax:718-222-4376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0675801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty