Provider Demographics
NPI:1902298359
Name:ABBOTT HOUSE
Entity Type:Organization
Organization Name:ABBOTT HOUSE
Other - Org Name:ABBOTT HOUSE CLINICAL AND COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-591-7300
Mailing Address - Street 1:100 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:10533-1254
Mailing Address - Country:US
Mailing Address - Phone:914-591-7300
Mailing Address - Fax:914-591-3236
Practice Address - Street 1:100 N BROADWAY # 6501242
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NY
Practice Address - Zip Code:10533-1254
Practice Address - Country:US
Practice Address - Phone:914-591-7300
Practice Address - Fax:914-650-1242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8532430251B00000X
261QM0801X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02704061Medicaid
NY01994458Medicaid
NY01358772Medicaid
NY02633374Medicaid
NY01364465Medicaid
NY02923559Medicaid
NY01353891Medicaid
NY04173759Medicaid
NY00333808Medicaid
NY01994476Medicaid
NY02257812Medicaid