Provider Demographics
NPI:1932212628
Name:RANDOLPH BLEIWAS CSW, PC
Entity Type:Organization
Organization Name:RANDOLPH BLEIWAS CSW, PC
Other - Org Name:HARBOR CREST COMPREHENSIVE COUNSELING GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEIWAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:845-354-9200
Mailing Address - Street 1:242 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5302
Mailing Address - Country:US
Mailing Address - Phone:845-354-9200
Mailing Address - Fax:845-354-8555
Practice Address - Street 1:242 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956
Practice Address - Country:US
Practice Address - Phone:845-354-9200
Practice Address - Fax:845-354-8555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0466781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN2W751Medicare ID - Type UnspecifiedMEDICARE GROUP ID