Organization
BLENDED CASE MANAGEMENT (ICL)
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEWEY H. HOWARD (CFO)
(212) 385-3030
Entity
Organization
Contact information
Practice address
2384 ATLANTIC AVE, BROOKLYN, NY 11233-3402
(718) 272-6025
Mailing address
125 BROAD STREET, 3RD FLOOR, NEW YORK, NY 10004-2400
(212) 385-3030
(917) 831-4451
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02256077
—
NY
Enumeration date
03/26/2007
Last updated
06/17/2015
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