Provider Demographics
NPI:1396047676
Name:THE GUIDANCE CENTER-CDTC
Entity type:Organization
Organization Name:THE GUIDANCE CENTER-CDTC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GELLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-636-4440
Mailing Address - Street 1:20 SICKLES AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-4030
Mailing Address - Country:US
Mailing Address - Phone:914-632-1374
Mailing Address - Fax:
Practice Address - Street 1:20 SICKLES AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-4030
Practice Address - Country:US
Practice Address - Phone:914-632-1374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE GUIDANCE CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY613936261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone