Organization
FREEPORT PRIDE
Active
Organization
FREEPORT PRIDE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. YOLANDA CARRION LCSW, CASAC (ASSISTANT DIRECTOR)
(516) 546-2822
Entity
Organization
Contact information
Practice address
33 GUY LOMBARDO AVE, FREEPORT, NY 11520-3637
(516) 546-2822
Mailing address
500 COOPER CT, UNIONDALE, NY 11553-2108
(516) 483-5772
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
161210916
NY
Other
Enumeration date
01/16/2015
Last updated
01/16/2015
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