Organization · Type 2 NPI

Eating Disorder Treatment of New York, LLC

Adolescent and Children Mental Health Clinic/Center · Northport, NY

NPI number 1699528950 Active

Practice location

254 Bread And Cheese Hollow Rd
Northport, NY 11768-2606

Call (631) 540-0980 Map

Fax (631) 967-1667

Mailing address

6100 SW 76th St
South Miami, FL 33143-5002

Specialties and licenses

Taxonomy	Code	License
Adolescent and Children Mental Health Clinic/Center Primary	261QM0855X	None listed

Adolescent and Children Mental Health Clinic/Center: An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training.

NPI record

NPI: 1699528950
Entity type: Organization (Type 2)
Issued: Apr 8, 2024
Last updated: Jun 5, 2025
Status: Active

Other names

<unavail>
Clementine North Shore · doing business as
Clementine North Shore · doing business as

Authorized official

Jason Schulz
Chief Financial Officer
(720) 440-4277

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1699528950

Eating Disorder Treatment of New York, LLC's National Provider Identifier is 1699528950, issued on Apr 8, 2024. The primary taxonomy on file is Adolescent and Children Mental Health Clinic/Center (261QM0855X), and the practice location is in Northport, NY. The record was last updated on Jun 5, 2025.