Provider Demographics
NPI:1255701892
Name:CHILD SERVICES INC NY
Entity type:Organization
Organization Name:CHILD SERVICES INC NY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GODNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-621-1281
Mailing Address - Street 1:59 COLONY LANE
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577
Mailing Address - Country:US
Mailing Address - Phone:516-621-1281
Mailing Address - Fax:516-621-1259
Practice Address - Street 1:59 COLONY LANE
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577
Practice Address - Country:US
Practice Address - Phone:516-621-1281
Practice Address - Fax:516-621-1259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-25
Last Update Date:2017-11-18
Deactivation Date:2017-11-14
Deactivation Code:
Reactivation Date:2017-11-17
Provider Licenses
StateLicense IDTaxonomies
NY251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04531857Medicaid