Provider Demographics
NPI:1306863535
Name:SPANISH SPEAKING ELDERLY COUNCIL-RAICES,INC.
Entity type:Organization
Organization Name:SPANISH SPEAKING ELDERLY COUNCIL-RAICES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LISETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOSA-DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:718-643-0232
Mailing Address - Street 1:460 ATLANTIC AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1704
Mailing Address - Country:US
Mailing Address - Phone:718-222-1518
Mailing Address - Fax:718-222-4376
Practice Address - Street 1:460 ATLANTIC AVE FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1704
Practice Address - Country:US
Practice Address - Phone:718-222-1518
Practice Address - Fax:718-222-4376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9137110A1041C0700X
NY0748201041C0700X
NY1943082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty