Provider Demographics
NPI:1881816643
Name:SERVICES FOR THE UNDERSERVED - MENTAL HEALTH PROGRAMS INC
Entity type:Organization
Organization Name:SERVICES FOR THE UNDERSERVED - MENTAL HEALTH PROGRAMS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MEDICAID BILLING
Authorized Official - Prefix:
Authorized Official - First Name:LIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:917-408-1642
Mailing Address - Street 1:305 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6008
Mailing Address - Country:US
Mailing Address - Phone:917-408-1611
Mailing Address - Fax:
Practice Address - Street 1:305 7TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6008
Practice Address - Country:US
Practice Address - Phone:917-408-1611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUS-MENTAL HEALTH PROGRAMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-02
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR033460-11041C0700X
NY216593-12084P0800X
320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty