Maryhaven Center of Hope Inc.

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

License

6825007A Issued in NY

Legal business name

MARYHAVEN CENTER OF HOPE INC.

Practice address

445 County Road 101
Yaphank, NY 11980

Phone

(631) 924-5900

Fax

(631) 924-2464

NPI assigned

Aug 15, 2007

Last updated

May 1, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Laura Pepper

Title

Director of Finance

Phone

(631) 474-4120

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1187136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430438400000",
    "number": "1417149386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 TERRYVILLE ROAD",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "11776",
            "telephone_number": "631-474-4120",
            "fax_number": "631-474-1312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 COUNTY ROAD 101",
            "city": "YAPHANK",
            "state": "NY",
            "postal_code": "11980",
            "telephone_number": "631-924-5900",
            "fax_number": "631-924-2464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYHAVEN CENTER OF HOPE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-15",
        "last_updated": "2015-05-01",
        "status": "A",
        "authorized_official_last_name": "PEPPER",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "631-474-4120"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NY",
            "license": "6825007A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03012315",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Khin M Latt, M.D.
• Richard Joseph Lopez, PH.D.
• Nicole Marengo
• Coryn Martin
• Emily Lynn Martino, MSED
• Jillian Maute, LPN
• Carleen A Mazzie
• Linda McCarthy, MSW
• Bonnie McCluskey, PH.D
• Laura A McGee-Chiusano, LCSW-R, CASAC

• Adult Mental Health Clinic/Center in Yaphank, NY
• Providers in Yaphank, NY by specialty
• Adult Mental Health Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.