Provider Demographics
NPI:1306242649
Name:BROOKLYN CENTER FOR FAMILIEZ IN PRACTICE
Entity type:Organization
Organization Name:BROOKLYN CENTER FOR FAMILIEZ IN PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARKIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:718-282-4411
Mailing Address - Street 1:12360 83RD AVE
Mailing Address - Street 2:4P
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3452
Mailing Address - Country:US
Mailing Address - Phone:347-233-2715
Mailing Address - Fax:
Practice Address - Street 1:1309 FOSTER AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-1511
Practice Address - Country:US
Practice Address - Phone:718-282-0010
Practice Address - Fax:718-693-4490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP95286261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health