Provider Demographics
NPI:1588764401
Name:TOWN OF BABYLON - DIVISION OF DRUG AND ALCOHOL SERVICES
Entity type:Organization
Organization Name:TOWN OF BABYLON - DIVISION OF DRUG AND ALCOHOL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:AUDREY
Authorized Official - Last Name:BOCKLET
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R, CASAC
Authorized Official - Phone:631-422-7676
Mailing Address - Street 1:281 PHELPS LANE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703
Mailing Address - Country:US
Mailing Address - Phone:631-422-7676
Mailing Address - Fax:631-422-7609
Practice Address - Street 1:281 PHELPS LANE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703
Practice Address - Country:US
Practice Address - Phone:631-422-7676
Practice Address - Fax:631-422-7609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070411544324500000X
NY170411544251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility