Organization
INTERBOROUGH DEVELOPMENTAL AND CONSULTATION CENTER, INC.
Active
Other names
LSA Recovery
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN GERSTEN PSY.D. (CEO)
(929) 273-7601
Entity
Organization
Contact information
Practice address
1623 KINGS HWY, BROOKLYN, NY 11229-1209
(718) 375-1200
(718) 382-3358
Mailing address
1623 KINGS HWY, BROOKLYN, NY 11229-1209
(718) 375-1200
(718) 382-3358
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
2084P0800X
Psychiatry Physician
—
—
251B00000X
Case Management Agency
Primary
6989100A
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00245318
—
NY
Enumeration date
05/30/2006
Last updated
04/19/2021
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