# EATING DISORDER TREATMENT OF NEW YORK, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Clementine Hudson Valley
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861076150
- **Authorized official:** MR. JASON SCHULZ (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (720) 440-4277

## Contact information

- **Practice address:** 171 MAIN ST, SOUTH SALEM, NY 10590-1210
- **Practice address phone:** (305) 663-1876
- **Practice address fax:** (786) 359-4485
- **Mailing address:** 6100 SW 76TH ST, SOUTH MIAMI, FL 33143-5002
- **Mailing address phone:** (305) 663-1876

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | Yes |
| 320800000X | Mental Illness Community Based Residential Treatment Facility | — | NULL | — |

## Other

- **Enumeration date:** 05/12/2021
- **Last updated:** 06/11/2025