Abbott House
Organization Active NPI Adolescent and Children Mental Health Clinic/Center · Irvington, NY
NPI 1902298359 · NPPES record last updated Oct 2, 2019
Key facts
- NPI
- 1902298359
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Adolescent and Children Mental Health Clinic/Center 261QM0855X
- Legal business name
- ABBOTT HOUSE
- Practice address
- 100 N Broadway # 6501242
Irvington, NY 10533-1254 - Phone
- (914) 591-7300
- Fax
- (914) 650-1242
- NPI assigned
- Feb 23, 2015
- Organization subpart
- No
Authorized official
- Name
- Mr. Gerard Finn
- Title
- Cfo
- Phone
- (914) 591-7300
Corporate family (same tax ID) 4
Practitioners 8
-
Moitri Nath Datta, M.D.
-
Deborah S Given, LCSW
-
Wendy Rawson, LCSW
-
Linden Schild, MD
-
Julie C Lopez, LMSW
-
William Beacher, PSY.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 33D2275227 | Abbott House | Certificate of waiver | Mar 26, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150908001670 | NY | Part B Supplier - Clinic/Group Practice | 4880900794 |
Receives reassigned benefits from 8 practitioners Practice locations: Irvington, NY |
National Provider Directory
- Tax ID family
- Abbott House
Locations
100 N Broadway
Irvington, NY 10533
Phone (914) 591-7300
100 Commerce Dr
New Windsor, NY 12553
Phone 9145917300 ext. 3023
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Management Agency | 251B00000X | 8532430 | NY | |
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | |||
| Adolescent and Children Mental Health Clinic/Center | 261QM0855X | Yes |
Addresses
Primary practice location
100 N Broadway # 6501242
Irvington, NY 10533-1254
Mailing address
100 N Broadway
Irvington, NY 10533-1254
Phone (914) 591-7300
Other practice location 1
100 Commerce Dr
New Windsor, NY 12553-6937
Phone (914) 591-7300 ext. 3023
Other practice location 2
1775 Grand Concourse
Bronx, NY 10453-8202
Phone (718) 329-4968 ext. 3448
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02704061 | Medicaid | NY | |
| 01994458 | Medicaid | NY | |
| 01358772 | Medicaid | NY | |
| 02633374 | Medicaid | NY | |
| 01364465 | Medicaid | NY | |
| 02923559 | Medicaid | NY | |
| 01353891 | Medicaid | NY | |
| 04173759 | Medicaid | NY | |
| 00333808 | Medicaid | NY | |
| 01994476 | Medicaid | NY | |
| 02257812 | Medicaid | NY |
Other names
- Abbott House Clinical and Counseling Services
Other providers in Irvington, NY
- Abbott House
- Abbott House
- Abbott House
- Abbott House, Inc.
- Jessica Nicole Alicea
- Armin William Brand Allen
- Rena Ilyse Allen
- Amber Dasilva
All providers in Irvington, NY · Adolescent and Children Mental Health Clinic/Center in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 2, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.