Provider Demographics
NPI:1174784383
Name:164TH STREET CONSULTING, INC
Entity type:Organization
Organization Name:164TH STREET CONSULTING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KNAUST
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:718-428-2640
Mailing Address - Street 1:4535 194TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3533
Mailing Address - Country:US
Mailing Address - Phone:718-428-2640
Mailing Address - Fax:
Practice Address - Street 1:4535 194TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-3533
Practice Address - Country:US
Practice Address - Phone:718-428-2640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075936251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health