Organization Name: | 214-18 HILLSIDE AVE |
NPI Number: | 1063858991 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GRACEMON KURIAKOSE (CEO) |
Mailing Address: | 21418 Hillside Ave Queens Village |
State: | NY US |
Postal Code: | 114271808 |
Phone Number: | 6463317345 |
Fax Number: | |
NPI Enumeration Date: | 05/19/2013 |
NPI Last Update Date: | 05/19/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |