Provider First Line Business Practice Location Address:
669 CASTLETON AVE
Provider Second Line Business Practice Location Address:
STATEN ISLAND MENTAL HEALTH SOCIETY
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-442-2225
Provider Business Practice Location Address Fax Number:
718-442-2289
Provider Enumeration Date:
06/01/2006