Basic Information
| Provider Information | |||||||||
| NPI: | 1033659495 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TRI CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2488 GRAND CONCOURSE SUITE 417 | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185847204 | ||||||||
| FaxNumber: | 7185848394 | ||||||||
| Practice Location | |||||||||
| Address1: | 2488 GRAND CONCOURSE SUITE 417 | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185847204 | ||||||||
| FaxNumber: | 7185848394 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2017 | ||||||||
| LastUpdateDate: | 03/06/2017 | ||||||||
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| AuthorizedOfficialLastName: | SKROBACZ | ||||||||
| AuthorizedOfficialFirstName: | ANETA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CLINICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7185847204 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CASAC, LPMHC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | P99531 | NY | Y | Agencies | Community/Behavioral Health |
No ID Information.