| North Crown Heights Family Outreach Center Inc | |
|
765 Nostrand Ave Brooklyn NY 11216-4203 | |
| (718) 398-8700 | |
| (718) 398-5770 |
| Full Name | North Crown Heights Family Outreach Center Inc |
|---|---|
| Speciality | Counselor |
| Location | 765 Nostrand Ave, Brooklyn, New York |
| Authorized Official Name and Position | Bertholet Desir (MEDICAL DIRECTOR) |
| Authorized Official Contact | 7183988700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| North Crown Heights Family Outreach Center Inc 765 Nostrand Ave Brooklyn NY 11216-4203 Ph: (718) 398-8700 | North Crown Heights Family Outreach Center Inc 765 Nostrand Ave Brooklyn NY 11216-4203 Ph: (718) 398-8700 |
| NPI Number | 1558419762 |
|---|---|
| Provider Enumeration Date | 01/07/2007 |
| Last Update Date | 12/27/2024 |
| Certification Date | 12/27/2024 |
| Medicare PECOS PAC ID | 5698737393 |
|---|---|
| Medicare Enrollment ID | O20041103000780 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558419762 | NPI | - | NPPES |
| 02252972 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 050411459 (New York) | Primary |
| Provider Name | Bertholet Desir |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1730108390 PECOS PAC ID: 1052386380 Enrollment ID: I20040929000125 |
| Provider Name | Joseph N Charles |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1851470637 PECOS PAC ID: 2062435886 Enrollment ID: I20060109000008 |
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