NORTHEAST COMMUNITY CENTER FOR MENTAL HEALTH-MENTAL RETARDATION INC. (NPI# 1225693328) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225693328 |
| Entity Type | Organization |
| Organization Name | NORTHEAST COMMUNITY CENTER FOR MENTAL HEALTH-MENTAL RETARDATION INC. |
| Other Organization Name | NORTHEAST COMMUNITY CENTER FOR BEHAVIORAL HEALTH |
| Practice Address |
4371 Waln St Philadelphia PA 19124-4010 |
| Mailing Address |
4641 Roosevelt Blvd Philadelphia PA 19124-2343 |
| Practice Telephone | 2158312826 |
| Mailing Telephone | 2158312836 |
| Enumeration Date | 2019-05-03 |
| Last Update Date | 2019-05-03 |
| Authorized Official Name | DENNIS GUSCOTT (DEPUTY DIRECTOR) |
| Authorized Official Telephone | 2158312826 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Northeast Community Center for Behavioral Health | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457896565 | Northeast Community Center for Mental Health-mental Retardation Inc. | Community Based Residential Treatment Facility, Mental Illness | 4641 Roosevelt Blvd, Philadelphia, PA 19124-2343 | 2016-12-28 |
| 1306210703 | Northeast Community Center for Mental Health-mental Retardation Inc. | Community Based Residential Treatment Facility, Mental Illness | 4641 Roosevelt Blvd, Orleans Bldg, Philadelphia, PA 19124-2343 | 2015-11-23 |
| 1396119798 | Northeast Community Center for Mental Health-mental Retardation Inc. | Community Based Residential Treatment Facility, Mental Illness | 4641 Roosevelt Blvd, Orleans Building, Philadelphia, PA 19124-2343 | 2015-11-23 |
| Street Address |
4371 WALN ST |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19124-4010 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972651248 | Northeast Community Center for Mental Health & Mental Retardation | Clinic/Center | 4371 Waln St, Philadelphia, PA 19124-4010 | 2007-01-05 |
| 1588174213 | Amanda Falivene-rocco | Counselor | 4371 Waln St, Philadelphia, PA 19124-4010 | 2017-10-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831749308 | William Mark Hanna Sr. | Pharmacist | 4600 Rooselvelt Blvd Bldg G, Philadelphia, PA 19124 | 2019-09-17 |
| 1881256451 | Medical Discovery Systems, LLC | Durable Medical Equipment & Medical Supplies | 5425 Oxford Ave., 5425 Oxford Ave. Suite (3 A), Philadelphia, PA 19124 | 2019-07-03 |
| 1548731391 | Sierra Pinkney | Registered Nurse | 1615 Granite St, Philadelphia, PA 19124 | 2018-12-05 |
| 1922507987 | Xavier Sergio Henriquez | Counselor | 4510 Frankford Avenue 2nd Floor, Philadelphia, PA 19124 | 2018-02-06 |
| 1558881581 | Isabel Cristina Castillo Hernandez | Pediatrics | 4500-10, Apt 201b, Philadelphia, PA 19124 | 2017-06-21 |
| 1952843732 | Patrick Grugan | Social Worker | Roosevelt Boulevard & Adams Avenue, Philadelphia, PA 19124 | 2016-11-10 |
| 1811340482 | Katarzyna Liwski | Psychiatry & Neurology | 4641 Roosevelt Boulevard, E212, Drexel University College of Medicine Friends Hospital, Philadelphia, PA 19124 | 2016-07-19 |
| 1851769327 | Aleka Kostouros | Social Worker | Roosevelt Blvd & Adams Ave, Northeast Community Center for Behavioral Health, Philadelphia, PA 19124 | 2015-09-14 |
| 1407230378 | Sara Bachani | Psychiatry & Neurology | 4641 Roosevelt Blvd, Friends Hospital, Room 231, Philadelphia, PA 19124 | 2015-07-10 |
| 1215327051 | Alyssa Renee Kirk | Counselor | 4500-10 Frankford Ave, 2nd Floor, Philadelphia, PA 19124 | 2015-02-02 |
| Find all providers in zip 19124 | ||||
| Taxonomy Code | 261QM0850X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adult Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235738360 | Hallie M. Kushner, Ph.d. P.C. | Clinic/Center | 1601 Walnut St Ste 706, Philadelphia, PA 19102-2904 | 2020-10-20 |
| 1114534328 | Virtual Sofa, LLC | Clinic/Center | 2005 Market St Ste 3140, Philadelphia, PA 19103-7001 | 2020-09-30 |
| 1942819958 | Shay Selden, Psyd, Med, LLC | Clinic/Center | 1411 S 15th St, Philadelphia, PA 19146-4803 | 2020-07-26 |
| 1952939068 | King Motivates, LLC | Clinic/Center | 1939 Page St, Philadelphia, PA 19121-1513 | 2020-04-01 |
| 1104470665 | Thibault Counseling LLC | Clinic/Center | 2049 North Street, Philadelphia, PA 19130 | 2019-08-01 |
| 1235781220 | Annie Strout Counseling LLC | Clinic/Center | 1713 S Dorrance St, Philadelphia, PA 19145-2108 | 2019-07-10 |
| 1497170625 | Citywide Community Counseling Services | Clinic/Center | 537 E. Allegheny Avenue, Apt/suite, Philadelphia, PA 19134 | 2014-02-25 |
| 1598189771 | Citywide Community Counseling Services | Clinic/Center | 1346 Knorr St, Philadelphia, PA 19149 | 2014-02-10 |
| 1780008961 | Citywide Community Counseling Services | Clinic/Center | 137 E. Allegheny Avenue, Philadelphia, PA 19134 | 2014-02-10 |
| 1114341328 | Citywide Community Counseling Services | Clinic/Center | 5807 Bustleton Avenue, Philadelphia, PA 19149 | 2014-02-07 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19124 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.