Provider Demographics
NPI:1053613489
Name:ASSOCIATION TO BENEFIT CHILDREN-FAST BREAK MOBILE MENTAL HEALTH CLINIC
Entity type:Organization
Organization Name:ASSOCIATION TO BENEFIT CHILDREN-FAST BREAK MOBILE MENTAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LECZYCKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-459-6166
Mailing Address - Street 1:1841 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-1316
Mailing Address - Country:US
Mailing Address - Phone:646-459-6142
Mailing Address - Fax:
Practice Address - Street 1:1841 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1316
Practice Address - Country:US
Practice Address - Phone:646-459-6142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSOCIATION TO BENEFIT CHILDREN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075566251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health