Concern for Independent Living, Inc.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

7609432 Issued in NY

Legal business name

CONCERN FOR INDEPENDENT LIVING, INC.

Practice address

312 Expressway Drive South
Medford, NY 11763

Phone

(631) 750-2225

Fax

(631) 758-0467

NPI assigned

Feb 8, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Ralph Fasano

Title

Executive Director

Phone

(631) 758-0474

Specialties & licenses 2

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brittany Kristin Clark, LMHC

  • Mental Health Counselor
  • West Babylon, NY
  • NPI 1255040069
  NPD (past)
• Esther Williams Ekanem, LMHC, CASAC, NCC

  • Mental Health Counselor
  • Medford, NY
  • NPI 1215405980
  NPD (past)
• James Samuel Mutton, LMSW

  • Social Worker
  • Brooklyn, NY
  • NPI 1942918602
  NPD (past)

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463529600000",
    "number": "1427198209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 358",
            "address_2": "312 EXPRESSWAY DRIVE SOUTH",
            "city": "MEDFORD",
            "state": "NY",
            "postal_code": "11763",
            "telephone_number": "631-758-0474",
            "fax_number": "631-758-0467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 EXPRESSWAY DRIVE SOUTH",
            "city": "MEDFORD",
            "state": "NY",
            "postal_code": "11763",
            "telephone_number": "631-750-2225",
            "fax_number": "631-758-0467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONCERN FOR INDEPENDENT LIVING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-08",
        "last_updated": "2016-05-18",
        "status": "A",
        "authorized_official_last_name": "FASANO",
        "authorized_official_first_name": "RALPH",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "631-758-0474",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NY",
            "license": "7609432",
            "primary": true
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jaquell Clark
• Lorie Clinnin
• Kenya D Clinton-Coles
• Cole Chiropractic PC
• Frances Colon, LCSW
• Erin Kelly Connell, MS
• Eric Connolly, LPN
• Maeve Connolly
• Thomas Graham Conway, OTR/L
• Kristina Corbett, LMSW

• Community/Behavioral Health Agency in Medford, NY
• Providers in Medford, NY by specialty
• Community/Behavioral Health Agency in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2016; 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.