Provider Demographics
NPI:1316104011
Name:SAFE SPACE NYC, INC.
Entity type:Organization
Organization Name:SAFE SPACE NYC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:NAHIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUHAMDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-226-3536
Mailing Address - Street 1:295 LAFAYETTE ST
Mailing Address - Street 2:SUITE 920
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-2701
Mailing Address - Country:US
Mailing Address - Phone:212-226-3536
Mailing Address - Fax:212-226-1918
Practice Address - Street 1:1931 MOTT AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4103
Practice Address - Country:US
Practice Address - Phone:718-471-6818
Practice Address - Fax:718-337-2750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7055120B1041C0700X, 2084P0800X, 2084P0804X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00368387Medicaid