1487888277 NPI number — COMMUNITY RESOURCES OF NEW YORK, LLC

Table of content: DR. BRALIN LEE BARNES PSYD (NPI 1154081461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487888277 NPI number — COMMUNITY RESOURCES OF NEW YORK, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY RESOURCES OF NEW YORK, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487888277
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
352 WEST 117TH STREET, SUITE 4D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10026-1558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-316-0829
Provider Business Mailing Address Fax Number:
212-678-0411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
352 WEST 117TH STREET, SUITE 4D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10026-1558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-316-0829
Provider Business Practice Location Address Fax Number:
212-678-0411
Provider Enumeration Date:
05/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
ROSALIND
Authorized Official Middle Name:
V.
Authorized Official Title or Position:
PRESIDENT/MANAGER
Authorized Official Telephone Number:
212-316-0829

Provider Taxonomy Codes

  • Taxonomy code: 252Y00000X , with the licence number:  036141-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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