| Ccms | |
|
25 Elm Pl Fl 2 Brooklyn NY 11201-5355 | |
| (718) 802-0666 | |
| (718) 858-9493 |
| Full Name | Ccms |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 25 Elm Pl Fl 2, Brooklyn, New York |
| Authorized Official Name and Position | Emory X. Brooks (PRESIDENT & CEO) |
| Authorized Official Contact | 7188020666 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ccms 25 Elm Pl Fl 2 Brooklyn NY 11201-5355 Ph: (718) 802-0666 | Ccms 25 Elm Pl Fl 2 Brooklyn NY 11201-5355 Ph: (718) 802-0666 |
| NPI Number | 1003028549 |
|---|---|
| Provider Enumeration Date | 05/04/2007 |
| Last Update Date | 04/24/2018 |
| Medicare PECOS PAC ID | 5294960936 |
|---|---|
| Medicare Enrollment ID | O20131105000444 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003028549 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 7655100A (New York) | Primary |
| Provider Name | Sylvia E Reyes |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144208539 PECOS PAC ID: 2062404452 Enrollment ID: I20040402001306 |
| Provider Name | Phyllis Hyatt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104902733 PECOS PAC ID: 1759357908 Enrollment ID: I20040908001396 |
| Provider Name | Donn J Wiedershine |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1205866670 PECOS PAC ID: 5597721894 Enrollment ID: I20041208000746 |
| Provider Name | Junie M Kernisan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023113578 PECOS PAC ID: 0042250649 Enrollment ID: I20050503000886 |
| Provider Name | Joanna Fahey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942238217 PECOS PAC ID: 2365442050 Enrollment ID: I20070103000031 |
| Provider Name | Thomas W Perron |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710179825 PECOS PAC ID: 1052477734 Enrollment ID: I20090304000540 |
| Provider Name | David Bela Horvath |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639499353 PECOS PAC ID: 0749440006 Enrollment ID: I20120322000680 |
| Provider Name | Robert J Jaffe |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1881919256 PECOS PAC ID: 1759505530 Enrollment ID: I20140618000015 |
| Provider Name | Stacie A Dee |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306194014 PECOS PAC ID: 0345476735 Enrollment ID: I20150116002103 |
| Provider Name | Althea L Jureidini |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720252471 PECOS PAC ID: 5193041515 Enrollment ID: I20150303000262 |
| Provider Name | Jesse Lee Costales |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619266897 PECOS PAC ID: 9335469261 Enrollment ID: I20150518000687 |
| Provider Name | June Tyson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902056211 PECOS PAC ID: 0446560403 Enrollment ID: I20151104001391 |
| Provider Name | Sarah E Cohen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609265628 PECOS PAC ID: 6507166717 Enrollment ID: I20151119001681 |
| Provider Name | Dorothy Chyung |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164798740 PECOS PAC ID: 5395046148 Enrollment ID: I20151221000733 |
| Provider Name | Susan Brady |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346685799 PECOS PAC ID: 4789981762 Enrollment ID: I20160318001957 |
| Provider Name | Awilda Castro |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679764336 PECOS PAC ID: 9931285608 Enrollment ID: I20160503000646 |
| Provider Name | Jason V Meisel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669859096 PECOS PAC ID: 0244520583 Enrollment ID: I20160527001547 |
| Provider Name | Debra A Rock |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346422367 PECOS PAC ID: 8325338668 Enrollment ID: I20160527001565 |
| Provider Name | Gary D Siegel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194968206 PECOS PAC ID: 4789977141 Enrollment ID: I20160721002393 |
| Provider Name | Jesse J Astwood |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366885493 PECOS PAC ID: 3577841071 Enrollment ID: I20161104000423 |
| Provider Name | Cheryl D Turner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881723153 PECOS PAC ID: 7911287990 Enrollment ID: I20161208001577 |
| Provider Name | Eva Spears-smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679010698 PECOS PAC ID: 3274895818 Enrollment ID: I20180320002002 |
| Provider Name | Rachel M Castro |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679968879 PECOS PAC ID: 2163784612 Enrollment ID: I20180320002901 |
| Provider Name | Iliana Kaufman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184998767 PECOS PAC ID: 1951651793 Enrollment ID: I20180829001486 |
| Provider Name | Latoya A Delmadge |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174924302 PECOS PAC ID: 3971846577 Enrollment ID: I20190523000346 |
| Provider Name | Dan Liu |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396101549 PECOS PAC ID: 3375963150 Enrollment ID: I20201015003214 |
| Provider Name | Michael Nakhla |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063943306 PECOS PAC ID: 5890049324 Enrollment ID: I20201030001924 |
| Provider Name | Elena Youmans |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528652401 PECOS PAC ID: 1254710593 Enrollment ID: I20220616002800 |
| Provider Name | Nataliya Bennett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366064644 PECOS PAC ID: 8729453477 Enrollment ID: I20230411000616 |
| Provider Name | Karen A Whittaker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760193262 PECOS PAC ID: 3779949458 Enrollment ID: I20230523000863 |
| Provider Name | Sansan Ma |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770192114 PECOS PAC ID: 8820458078 Enrollment ID: I20230719001595 |
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