NPIMap

Organization Active NPI

Behavioral Enhancement & Substance Abuse Medicine Treatment PLLC

  • Community/Behavioral Health Agency
  • Deer Park, NY
National Provider Identifier
1346680071
Registry record updated Dec 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
140511797 Issued in NY
Legal business name
BEHAVIORAL ENHANCEMENT & SUBSTANCE ABUSE MEDICINE TREATMENT PLLC
Practice address
770 Grand Blvd
Suite 17
Deer Park, NY 11729-5750
Phone
(631) 392-4357
Fax
(631) 392-4358
NPI assigned
Jun 26, 2013
Last updated
Dec 4, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Deborah M. Petry, LCSW, CASACNPI 1497856108
Title
Program Supervisor
Phone
(631) 392-4357

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 140511797 NY Primary

Addresses

Primary practice location

770 Grand Blvd
Suite 17
Deer Park, NY 11729-5750

Mailing address

770 Grand Blvd
Suite 17
Deer Park, NY 11729-5750
Phone (631) 392-4357

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140512001557 NY Part B Supplier - Clinic/Group Practice 9436382777 Receives reassigned benefits from 3 practitioners
Practice locations: Deer Park, NY

National Provider Directory

National Provider Directory

Locations

770 Grand Blvd
Ste 17
Deer Park, NY 11729
Phone (631) 392-4357

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1372204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386115200000",
    "number": "1346680071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "770 GRAND BLVD",
            "address_2": "SUITE 17",
            "city": "DEER PARK",
            "state": "NY",
            "postal_code": "117295750",
            "telephone_number": "631-392-4357",
            "fax_number": "631-392-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 GRAND BLVD",
            "address_2": "SUITE 17",
            "city": "DEER PARK",
            "state": "NY",
            "postal_code": "117295750",
            "telephone_number": "631-392-4357",
            "fax_number": "631-392-4358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEHAVIORAL ENHANCEMENT & SUBSTANCE ABUSE MEDICINE TREATMENT PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-26",
        "last_updated": "2013-12-04",
        "status": "A",
        "authorized_official_last_name": "PETRY",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PROGRAM SUPERVISOR",
        "authorized_official_telephone_number": "631-392-4357",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW, CASAC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NY",
            "license": "140511797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Deer Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.