Provider Demographics
NPI:1215479746
Name:CREEDMORE PSYCHIATRIC CENTER
Entity type:Organization
Organization Name:CREEDMORE PSYCHIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMHN
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIBEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DELROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:BSN RN
Authorized Official - Phone:646-932-8160
Mailing Address - Street 1:7324 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1503
Mailing Address - Country:US
Mailing Address - Phone:646-932-8160
Mailing Address - Fax:718-672-2386
Practice Address - Street 1:7324 52ND AVE
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-1503
Practice Address - Country:US
Practice Address - Phone:646-932-8160
Practice Address - Fax:718-672-2386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY586572251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health