Provider Demographics
NPI:1174934889
Name:ANGEL SIERRA
Entity type:Organization
Organization Name:ANGEL SIERRA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE ABUSE COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SIERRA
Authorized Official - Suffix:
Authorized Official - Credentials:CASAC-T
Authorized Official - Phone:718-827-8700
Mailing Address - Street 1:2640 PITKIN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-2629
Mailing Address - Country:US
Mailing Address - Phone:718-827-8700
Mailing Address - Fax:
Practice Address - Street 1:2640 PITKIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-2629
Practice Address - Country:US
Practice Address - Phone:718-827-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29778101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY52213Medicaid