Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 261QM0801X | Clinic/Center | Mental Health (Including Community Mental Health Center) | | | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | ========= | OTHER | | UBA ID # |
| 2 | ========= | OTHER | | HEALTH INTEGRATED ID # |
| 3 | =========-044 | OTHER | | HEALTHFIRST PROVIDER # |
| 4 | 04121000000 | OTHER | | CENTER CARE ID # |
| 5 | ========= | OTHER | | UNION LABOR LIFE |
| 6 | 00759944 | MEDICAID | NEW YORK | |
| 7 | 118353 | OTHER | | HARMONY PROVIDER # |
| 8 | ========= | OTHER | | 1199 ID # |
| 9 | W07991 | MEDICARE ID-TYPE UNSPECIFIED | | |
| 10 | 041210000000 | OTHER | | FIDELIS ID# |
| 11 | 1037430 | OTHER | | BEACON PROV # |
| 12 | 142975 | OTHER | | VALUEOPTIONS PROVIDER # |
| 13 | ========= | OTHER | | ALL UNION LOCALS |
| 14 | =========-178 | OTHER | | HEALTFIRST PROVIDER # |
| 15 | =========5B | OTHER | | COMMUNITY CHOICE ID# |
| 16 | 251311 | OTHER | | COMP PSYCH ID # |
| 17 | ========= | OTHER | | METROPLUS ID # |
| 18 | ========= | OTHER | | HIP ID # |
| 19 | 3106231 | OTHER | | GHI PROVIDER # |
