Provider Demographics
NPI:1306128814
Name:ROCKLAND CHILDREN'S PSYCHIATRIC CENTER
Entity type:Organization
Organization Name:ROCKLAND CHILDREN'S PSYCHIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC SOCIAL WORKER II
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:845-623-0085
Mailing Address - Street 1:2 FIRST AVENUE
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962
Mailing Address - Country:US
Mailing Address - Phone:845-680-4000
Mailing Address - Fax:
Practice Address - Street 1:65 PARROTT ROAD BUILDING 6
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994
Practice Address - Country:US
Practice Address - Phone:845-623-0085
Practice Address - Fax:845-627-6302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2683502A283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital