Organization
INSTITUTE FOR COMMUNITY LIVING , INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RENIE ELIZABETH MARIE RONDON JACKSON LCSW (CLINIC DIRECTOR)
(718) 855-7485
Entity
Organization
Contact information
Practice address
13607 BROOKVILLE BLVD, ROSEDALE, NY 11422-1525
(718) 855-7485
Mailing address
136 ROCKVILLE BLVD, ROSEDALE, NY 11422-0000
(718) 855-7485
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
057800
NY
Other
Enumeration date
01/05/2007
Last updated
08/22/2020
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