Value Based Payment Community Based Organization Directory

  • Directory also available in Excel Format (XLSX)
All information contained in this directory is self–reported by community based organizations and is not verified by DOH. Please note, this directory is NOT an exhaustive list of CBOs across NYS. MCOs and VBP contractors may engage CBOs that may not be listed.
Name of Organization VBP Contact Person VBP Contact Phone VBP Contact Email Organization´s Website Link Counties Served Service(s) provided that address SDH for the NY Medicaid population. Please include any pertinent information such as targeted population, partnerships, etc. CBO Tier CBO IPA/network/consortium/HUB Managed Care Organization that the majority of your population is enrolled in MCO other MCO other 2
1978 JUAN C PINZON (646) 385–3569 jpinzon@cssny.org www.cssny.org All 62 Health insurance enrollment and navigation, income support services,financial coaching, reentry services and youth mentoring Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
1digit LLC Gail Nayowith 917–647–3053 gnayowith@1digit.nyc   nyc cvy Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
A New Hope Center Francis J Bialy 607–687–6887 franb@anewhopecenter.org www.anewhopecenter.org Tioga victim services, domestic violence, including shelter, rape crisis Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks CBO Consortium of Upstate NY unsure    
Abbott House Bridget Carter 914 365 6719 bcarter@abbotthouse.net https://www.abbotthouse.net/ New York, Bronx, Westchester, Rockland, Orange, Dutchess, Sullivan, Ulster Abbott House provides services across NYC and the Lower Hudson Valley including mental health services, CFTSS and HCBS services and supports for children and their families, Children´s Health Home Care Management, Foster Care services, mandated preventive services and residential options and Day Habilitation services for Adults with Developmental Disabilities. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   Metro Plus, MVP, Fidelis, HealthFirst, AffinityCare,    
Abbott House Bridget Carter 914 365 6719 bcarter@abbotthouse.net https://www.abbotthouse.net/ Bronx, New York, Westchester, Rockland, Orange, Dutchess, Sullivan, Ulster Foster Care, Children´s Behavioral Health Services and Supports, Children´s Mental Health, Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   Metro Plus, Fidelis, Healthfirst, MVP    
Acacia Network, Inc Gabriela Marinescu–Cruz 718–960–7568 gmarinescu@promesa.org www.acacianetwork.org Bronx, Kings, Queens and Manhattan Acacia Network stands in places of need, has well developed roots, and nurtures the community to reach its potential. We provide primary care, specialty care, mental health, substance abuse. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency AsOne IPA, Ince Healthfirst, Metroplus, Fidelis, Affinity and Wellcare    
ACLD Robert Ciatto 516–822–0028 ciattor@acld.org acld.org Suffolk and Nassau ACLD provides residential, day habilitation, respite (in home and group), community hab, education (pre–school), IPSIDD, recreation, supplemental day hab, vocational services Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency        
ACR Health Jeanette O´Connor–Shanley 315–475–2430 joconnorshanley@acrhealth.org www.ACRHealth.org Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Montgomery, Oneida, Onondaga, Oswego, St. Lawrence, Tioga, Tompkins Health Home Care Coordination, Rental Assistance and Housing Retention Services, LGBTQ youth and adult support services and groups, syringe exchange programs, drug user health services including acute medical services and MAT, HIV/STD/HCV testing and screening, NYS of Health Insurance enrollment services and supportive services including Nutrition, Medical Transportation, Behavioral Health Enrollment, Case Management, Employment. Strong partnerships in all 15 counites with health and human service providers. Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers Inclusive Alliance IPA Fidelis United Healthcare Excellus
Action for a Better Community Aaron Wicks (585) 325–5116 x4511 awicks@abcinfo.org www.abcinfo.org Monroe, Ontario ABC serves inidividuals and families with low–incomes –– virtual all ABC customers are Medicaid–enrolles. ABC provides employment, education, health outreach, housing and community mobilization support to these familes Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers I don´t recall the name of our consortium Not known    
Adolescent AIDS Program, Children´s Hospital at Montefiore Medical Center Debra Parmer, MS 718–882–0232 dparmer@adolescentaids.org www.adolescentaids.org Bronx, New York, Queens, Kings The Adolescent AIDS Program (AAP) holds the distinction of being the nation´s first adolescent–focused HIV/AIDS center, and is a leader in LGBTQ health care for youth. A model multidisciplinary program, the AAP maintains an ethos of caring, learning and teaching. In every aspect of our work with patients, health care systems and communities, we strive to maximize the health of all young people infected and affected by HIV/AIDS and to inspire them to reach their full potential. In our work to reduce the burden of HIV/AIDS on young people, we are committed to serving and working with several key stakeholders: All youth living with and at risk for HIV infection, especially youth of color and lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth; Families, friends and partners of youth living with or at risk for HIV infection; Health care systems that provide care to young people; Community–based organizations serving youth; and Public policy leaders with the power to improve outcomes for vulnerable youth. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency        
Adoptive and Foster Family Coalition of New York Renee Hettich 607–272–0034 renee@affcny.orh https://affcny.org Broome, Cayuga, Chemung, Chenango, Cortland, Madison, Schuyler, Tompkins, Columbia, Delaware, Dutchess, Greene, Orange, Putnam, Rockland, Sullivan, Ulster, Nassau, Suffolk We provide support for adoptive and guardianship families such as assessment, case management, in–home support, advocacy for services, parent support groups, referrals, programs for children and youth, and training/information. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Advocates For Autism Sally Colletti (607) 754–9694 advocatesforautism@yahoo.com www.advocatesforautism.com Broome, Chenango, Tioga, Tompkins, Delaware, Cortland, Dutchess Medicaid Brokering; Person–Centered Planning; Housing and Services Navigation; Health Literacy; SSA Representation; Guardianship and Supported Decision Making Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   United Healthcare Services; Excellus; Fidelis    
AIDS Service Ctr Lower Manhattan dba Alliance for Positive Change Marcy Thompson 212–645–0875 marcy@alliance.nyc www.alliance.nyc Bronx, Brooklyn, Manhattan,Queens The Alliance for Positive Change is a community based organization that helps New Yorkers living with HIV and other chronic illnesses make lasting positive changes towards health, housing, recovery and self–sufficiency. Our diverse range of individualized, professional services include access to healthcare, peer education and safe–practice counseling. Alliance programs promote positive change, self–respect, personal responsibility and connection to community. Care Management: Intensive support to access medical care, pharmacy, housing, and other key services to promote wellness and self–sufficiency. Harm Reduction & Recovery Services: Counseling, education, syringe exchange, coaching, and support to help active and recovering substance users reduce risk, access healthcare, connect with a caring community, and explore recovery at their own pace. Peer Training and Workforce Re–entry Services: Job–readiness skills training empowers individuals to become community leaders and role models, inspiring others to make healthy choices. Alliance Peer Educators provide services that maximize our impact – and gain marketable skills that lead to jobs in organizations citywide. HIV Prevention and Coaching: HIV and hepatitis C testing, rapid access to medical care, and risk reduction education that enables women, gay and bisexual men, and people with histories of addiction to get healthy and stay healthy. Supportive Housing: Short–term and permanent housing with a robust mix of onsite services that promote recovery, wellness and self–sufficiency for people facing multiple chronic conditions. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Engagewell IPA; https://engagewellipa.com Healthfirst, Metroplus, VNSNY CHOICE    
Albany County Rural Housing Alliance, Inc Tracy Gibeau 518–765–2425 ex 2588 tgibeau@acrha.org www.acrha.org Albany County ACRHA offers home repair grant to assist homeowners with health and safety repairs. Reverse Mortgage, Foreclosure and Pre–Purchase counseling is also offered. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Ali Forney Center Joey Lopez 212–206–0574 jlopez@aliforneycenter.org www.aliforneycenter.org Bronx,Manhattan,Brooklyn,Queens,Staten Island, Westchester and Long Island AFC serves LGBTQ Youth 16–24. We provide, Housing, Case Management, Mental and Physical Health screenings, Education and Employment training as well as meals Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Health First    
Alliance for Positive Change Evelyn Lopez 212.645.0875 x454 evelyn2@alliance.nyc https://alliance.nyc New York, Bronx, Kings, Queens, Richmond Every year alliance serves over 6,000 low–income New Yorkers with multiple chronic illnesses many of them seeking benefit assistance, housing stabilization, food and support coordinating their care. Under Housing stabilization we offer housing assistant to temporary housing , retention in permanent housing via emergency rental, utility assistant and legal consultation. We offer Food Prescription Program that includes nutritional education, meals, grocery pantry and food voucher distribution. Our care management services include accompaniment, social support , coordination with medical providers and services in the client´s community through HCBS services. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency EngageWell IPA Amida Care, Inc., Healthfirst PHSP, Inc., MetroPlus Health Plan, Inc., and SelectHealth.    
American Lung Association Claudia Guglielmo (516) 972–3850 claudia.guglielmo@lung.org Lung.org New York, Queens, Kings, Richmond, Bronx, Suffolk, Nassau, Westchester, Ulster, Sullivan, Orange, Dutchess, Niagra, Erie, Monroe The ALA Asthma Programs in NYS target efforts around asthma in those communities that experience the highest rates of asthma hospitalizations and ED visits. We accomplish this through health systems quality improvement projects and home–based asthma services and interventions. These efforts focus on chronic disease management, access to health services, physical environments, providing educational resources and supporting bi–directional community clinical partnerships and referrals. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Healthfirst, Healthplus, Fidelis, Anthem    
ANIBIC John F. DeBiase 347 594 2124 jdebiase@anibic.org anibic.org Queens Servies for the ID/DD population: Residential, Vocational, Day programs, recreational Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers   CDNY    
Apicha CHC Teresita R. Rodriguez 646 884 5377 trodriguez@apicha.org https://www.apicha.org New York, Queens, Kings, Richmond, Bronx Nutrition, Mental Health Services, Care Management, Insurance Enrollment, Health Literacy, HIV Prevention, Transgender Wellness Program Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency EngageWell IPA Health First, Amida Care SN, NYS Catholic Health Plan    
Arab American Association of New York Lauren Hawk 929–471–6604 lauren@arabamericanny.org www.arabamericanny.org Kings County AAANY offers mental health counseling services, facilitated support groups, and preventative health workshops to the Arab and Muslim community of Bay Ridge, Brooklyn. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Arab–American Family Support Center Ghadeer Ady 718–643–8000 ext.12 ghadeer@aafscny.org www.aafscny.org Kings County. Queens County, Bronx County, New York City County, Richmond County We provide health insurance coverage, SNAP enrollment, preventive services, anti–violence program services, mental health counselling, and wellness based activities for adults and children. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks CTHE Brooklyn Hub Affinity, Empire Blue cross blue shield, Emblem Health, Health First, Metro Plus, United Healthcare, Wellcare,    
Arc Herkimer Lorene Bass 315–574–7564 lbass@archerkimer.org www.archerkimer.org Herkimer County and some services in Oneida and Otsego Counties Arc Herkimer provides services and supports to individuals with intellectual and developmental disabilities through OPWDD, HCBS Waiver, and additionally provides supports for HCBS services for children and adults, employment services through contracts with ACCES VR and OMH. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Life Plan LLC NY CCO Fidelis; Excellus; OPTUM, MVP    
Arc of Onondaga Ruth Ann Riposa (315) 476–7441 ruthann.riposa@arcon.org www.arcon.org Onondaga County Arc of Onondaga is one of the largest providers of services to people with developmental disabilities in Onondaga County serving thousands of individuals and their families and employing over 500 people. With nearly 40 different sites throughout Central New York, Arc provides a wide array of opportunities including residential, day, employment and recreation programs and services. Unsure   Medicaid    
Arc Wayne Leah Flowers (315331) 774–1441 Leah.flowers@arcwayne.org www.arcwayne.org Wayne, Cayuga, Seneca, Monroe, Orleans, Niagara, Ontario Arc Wayne serves a wide variety of individuals including I/DD, Behavioral health, etc. We provide a vvariety of I/DD services including residential, vocational, and day services. We provide BH Care Management, BH HCBS, Access VR, Welfare to Work, Criminal Justice Programs, Meals on Wheels, Integrated Pre School, Etc. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency FLST BHCC, Consortium of the Finger Lakes (Arc´s) Excellus (PRIMARY), Fidelis, United Health Care, MVP    
Arthur Ashe Institute for Urban Health Faven Araya 718–826–4999 faraya@arthurasheinstitute.org https://www.arthurasheinstitute.org/ King County The Arthur Ashe Institute for Urban Health utilizes a model of community health empowerment and engagement to promote health equity and social justice through strategic partnerships, innovative community–based health promotion & research programs, and the preparation of a more diverse and inclusive workforce of health professionals. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   MetroPlus, Healthfirst    
Aspire of WNY Martha Farewell 716–505–5636 Martha.farewell@aspirewell.org www.aspirewny.org Erie, Niagara, Chautauqua Aspire of WNY specializes in supports and services for those with disabilities. Services include primary medical care, podiatry, rehabilitation services, residential services, employment training, day habilitation, community habilitation, childhood education and school to adult life transition. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Aspire Health Center is part of ther SNAPCAP IPA (SIPA)      
Association for Mental Health and Wellness Michael Stoltz (631) 471–7242 amontijo@mhaw.org http://mhaw.org/ Suffolk Adults with psychiatric disabilities, veterans, children care managment. We have partnerships with multiple organizations Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency RHS formerly AHN Healhfirst & United HC    
Astor Services for Children & Families Yvette Bairan 845–871–1097 or 845–871–1001 ybairan@astorservices.org www.astorservices.org Bronx, Westchester, Dutchess, Orange, Ulster Mental Health Services for youth and adolescents between the ages of 5 – 18. We also provide Early childhood services. We provide outpatient clinic services, day treatment, foster care services, residential services, care management, crisis services, and educational services. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency PWR, CBHS, As One.BHCC, CCBHO.Community Care. Health First Beacon MVP
Baker Hall Inc dba Baker Victory Services Sheila Hunt 716 828–9699 shunt@bakervictoryservices.org www.bakervictoryservices.org Erie, Niagara Our agency provides an array of services to children, adolescents and adults. We are diverse in that our many programs works with Developmentally Disabled in our OPWDD group homes, behavioral and/or dual diagnoses behavioral health/autism in our Intensive Treatment and Residential Treatment program. We work with children who have been displaced from their homes in both our emergency foster care and traditonal foster care programs. In our Preventive program we work with children and familes to keep the family unit in tact and prevent out of home placement. The Outpatient Mental health clinic works with children, adolsecents and adults on managing mental health concerns. They are also linked with a Psychiatrist for medication management. Our Community Based programs such as our Health Home program, childrens HCBS and adult HCBS programs work with children and families to assist with SDH such as housing instability, access to health care and mental health care, transporation barriers, linking to food pantires and early childhood intervention Unsure Value Network IPA Fidelis and Beacon Health Options    
Bay Ridge Center Marianne Nicolosi (718) 748–0650 mnicolosi@bayridgecenter.org   Kings County Home Delivered Meals, Friendly Visiting,mental health services, Case Assistance, Health Management, Evidence Based Exercise Programs, Congregate Meals, Benefits and Entitlements for older adults. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks Bay Ridge Center, Inc and Community Care Link unknown    
Bedford Stuyvesant Restoration Corporation Sarah Wolf (917) 267–5597 swolf@restorationplaza.org www.restorationplaza.org Kings Bedford Stuyvesant Restoration Corporation (Restoration), the nation´s first community development corporation, relentlessly pursues strategies to close gaps in family and community wealth to ensure all families in Central Brooklyn are prosperous and healthy. To that end, we partner with residents and businesses to improve the quality of life of Central Brooklyn by fostering economic self sufficiency, enhancing family stability and growth, promoting the arts and culture and transforming the neighborhood into a vibrant place to live, work and visit. As Central Brooklyn experiences gentrification, economic growth and investments, our strategy is to ensure integration rather than displacement of low and moderate income residents, especially people of color. Restoration was established in 1967 through grassroots activism and the bipartisan support of then Senators Robert F. Kennedy and Jacob Javits. With a 51 year track record, Restoration serves some 50,000 annually across the borough with a focus on the predominantly minority and low income Central Brooklyn communities of Bedford Stuyvesant, Brownsville, Bushwick and East New York. These communities are faced with poverty and unemployment that far exceed state and city averages, some of the lowest graduation rates in New York, and health disparities that disproportionately impact low income households of color. Restoration´s programs work together to promote the social, financial and physical health and well–being of residents and the community at large. Efforts span affordable housing, economic development, workforce development, asset building, education, financial counseling, health, and the arts and culture. Our efforts begin with the individual and involves changing household and community level spending patterns that undermine the wealth creation of low and moderate income households, while simultaneously advocating for policy and systems reform. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Behavioral Health Services North Shawn Sabella (518) 563–8000 ssabella@bhsn.org www.bhsn.org Clinton County, with limited services in Essex and Franklin Counties BHSN´s PROS, Supported Housing, STOP Domestic Violence, Supported Employment, and Supported Education programs serve adults 18+, while Health Home Care Management, Home and Community Based Services, and outpatient MH clinic services are available to adults and children. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Northwinds Integrated Health Network Fidelis    
Birch Family Services Josh Scher 212–616–1824 josh.scher@birchfamilyservices.org https://birchfamilyservices.org/ Manhattan, Kings, Bronx, Queens We provide Early Education/Special Educations, UPK, School age services to children, adolescents and adults with Intellectual Disabilities, Developmental Disabilities and/or Autism, Related Services, CACFP Food Program, Preschool Evaluations, Transition Services for aging out students, Day Habilitation, Pre–Vocational Services, Supported Employment, Employment, Children´s Residential Services, Individualized Residential Alternatives, Intermediate Care Facilities Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency New York Integrated Network IPA Not yet enrolled    
Bleeding Disorders Assoc. of NENY Karla Digirolamo (518) 729–3577 karla.d@bdaneny.org www.bdaneny.org Dutchess, Ulster, Delaware, Green, Columbia, Rensselaer, Albany, Schoharie, Otsego, Herkimer, Mongomery, Schenectady, Fulton, Saratoga, Warren, Hamilton, Lewis, Washington, Essex, St Lawrence, Franklin, and Clinton. BDANENY serves people affected by inherited bleeding disorders. We work closely with the Hemophilia Treatment Center in our service area and with other medical providers and social services agencies to ensure that our community has access to necessary health care services, prescription drugs including required blood factor products and support services. We also advocate for adequate insurance coverage including limiting unnecessary pre–authorizations, advocating to limit pre–existing condition exclusions, and ensuring patients can access the pharmacy and delivery method of their choice. We provide limited financial assistance to people who need such help for co–pay, transportation to medical appointments and other costs necessary to ensure their health and well–being. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Unknown    
Bleuler Psychotherapy Center Steven Helfand (718) 275–6010 steven.helfand@bleulerpc.org www.bleulerpc.org Queens, Brooklyn, Manhattan, Nassau Outpatient mental health and substance use treatment to included target populations of formerly incarcerated and alternatives to incarceration. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Behavioral Health NYC, IPA (BHNYC) Healthfirst, Beacon, Empire    
BOOM!Health Delilah Gavilanes (718) 295–5605 dgavilanes@boomhealth.org   USA Harm reduction services, Programs for PLWHA, Mental health, CHronic Medical condictions such as HCV, Health Homes,care coordination programs, nutritional programs for PLWHA, Trauma related programs, drop in services such as meals, showers and asccess to laundry and Syringe exchange programing Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers Argus/BOOM!Health Healthfirst Amidicare Metroplus
BRIDGES Susan Jenkins 315–697–3947 sjenkins@bridges–mccasa.org www.bridgescouncil.org Madison, Oneida and Herkimer information and referral, smoking cessation, tobacco control policies, suicide prevention training, LGBTQ support group, grief support groupEAP to help employees m Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks ARISE is our HUB through CNYCC      
Bronx Community Health Network Eleanor Larrier 718–405–7723 elarrier@bchnhealth.org bchnhealth.org Bronx At both health centers and in community settings, BCHN assesses for social determinants of health needs and addresses these needs through direct assistance and linkages to approriate resources. We target both patients at our health centers and community residents. We partner with multiple community resources such as faith based organizations, food pantries and other community based organziations. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Medicaid    
BronxWorks Shali Sharma 646.276.0702 vsharma@bronxworks.org www.bronxworks.org Bronx BronxWorks helps individuals and families improve their economic and social well–being. From toddlers to seniors, we feed, shelter, teach, and support our neighbors to build a stronger community. We offer a variety of services in different settings; addressing the social determinants of health is an essential part of our work. Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers   Health First Affinity Metro Plus
Brooklyn bureau of Community Services dba Brooklyn Community Services Janelle Farris (718) 310–5607 jfarris@wearebcs.org wearebcs.org Kings Mental health community supports (Club house), housing, PROS, education, employment Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   Affinity Health Plan Inc, MetroPlus Health Plan, Wellcare    
Brooklyn center for Independence of the Disabled Milenka Berengolc 718 998–3000 mberengolc@bcid.org BCID.org Kings county and city–wide BCID serves the disability population, including physical, mental, sensory, and cognitive disabilities. Both our staff and our board of directors have disabilities themselves. The disability population faces a multitude of interlocking barriers, and are overwhelmingly impacted by the social determinants of health, such as housing, transportation, health care, employment. BCID has partnered with Empire Blue Cross Blue Shield using BCID´s unique CHW program. We will be starting shortly another CHW program with Integra. BCID´s mission is to empower people with disabilities to become self–advocates and improve their quality of life. We are a member of the New York Association of Independent Living, and collaborrate with ACESS–VR. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks Communities Together for Health Equity (CTHE) and the Brooklyn Hub Integra, long–term managed care organization.    
brooks–tlc health–gowanda medical tracy stevens 716–532–8100 ext 7379 tstevens@tlchealth.org   chautauqua, erie, cattaraugus discuss or refer medicaid patients to health homes, behioral health if needed, give information to help if transportation is needed Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   Fidelis & Your Care (35% patients have medicaid product) Medicare (Ind Health, BCBS, 30% patients have medicare product) Commercial insurance–Ind Health, empire, etc
Buffalo Go Green Inc. Allison DeHonney 716–982–1270 Dehonn@outlook.com UrbanFV.com Erie & Niagara Urban farms & gardens, Mobile Produce Market, Nutrition Education, Access and Education to health food options serving families with food insecurity and working primary in food desert areas Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Community Health Centers of Buffalo & Niagara Falls    
Buffalo Prenatal Perinatal Network, INC. Marixsa Sanchez (716) 359–3049 ms@bppn.org   Erie The Buffalo Prenatal Perinatal Network, Inc. (BPPN) has an overall mission, to collaborate convene and coordinate with all the key maternal child stakeholders in the city of Buffalo as well as Erie County more specifically focuses on identifying and servicing clients in 13 of the 25 zip code areas (14201, 14202, 14207, 14208, 14210, 14211, 14212, 14213, 14214, 14215, 14216, 14218, and 14222) that are identified with the highest–risk neighborhoods). The ZIP codes areas are identified as high–need based on significantly poor birth outcome indicators, including infant and neonatal mortality rates; percentage of premature births, low birth weight births, late or no prenatal care; and the teen pregnancy and birth rates) with the express goal to improve maternal and infant health outcomes for high–need women and their families who reside in targeted high–risk areas. BPPN has successfully operated for over 32 years and has implemented broad population and evidence based interventions that enhance, promote and improve the perinatal health and care system in Buffalo´s city neighborhoods. BPPN has worked collaboratively with community providers to help identify problems of adequacy, acceptability and accessibility in the delivery of maternal and infant health. BPPN has initiated and continues to initiate activities to address these problems with resources provided by our own agency along with the support of a maternal child network of providers within the community. Our success is based on the implementation of programs/ services that have proven to have positive effects on the community, especially among high need populations who have the greatest deficits and are difficult to serve. BPPN aims to continue to work on and expand the development of multi–dimensional community–wide systems of integrated and coordinated community health programs and services. These include programs to reduce infant mortality, low birth weight and improve overall health outcomes while employing new initiatives to further our efforts to narrow the significant health disparities in our community. The Maternal Infant Community Health Collaboratives (Community Health Workers Program) has a long history of assisting with service and system navigation (e.g. helping clients figure out the services they need and how to access them) and we provide the proposed population with unique home visiting and comprehensive case management services. Monthly home visits enable Community Health Workers (CHWs) to screen and assess immediate needs and provide clients with an increased level of trust that in turn increase their level of participation. Our program provides trained staff that is culturally and linguistically coordinated with the target population to provide a community–based, trauma informed and harm reduction approach that helps with attaining the programs goals. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   BlueCross BlueShield of Western New York Independent Health–Health/MediSource Fidelis Care of New York; United Health Care, WellCare Health Plans; and YourCare Health Plan
Callen–Lorde Community Health Center Anthony Fortenberry (212) 271–7143 afortenberry@callen–lorde.org callen–lorde.org New York Callen–Lorde provides health and social services targeted toward New York´s LGBTQ communities. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency        
CAMBA, Inc. Michael Erhard 347 582–7110 michaele@camba.org www.camba.org Kings, Queens, Bronx, New York and Richmond counties CAMBA takes a comphrensive approach to helping individuals, families and communities thrive with programs in Economic Developmet, Education and Youth Development, Family Support, Health, Housing and Legal Services. CAMBA reaches 60,000 individuals and families each year. 85% of families served are living in poverty. Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers Engage Well, IPA Health First, Metroplus, and Health Plus    
Camelot of Staten Island Inc. Logan Lewis (718) 632–3275 LLewis@camelotcounseling.com Camelot of Staten Island Inc. Richmond, Queens, Bronx Substance Use Disorder both Residential and Outpatient, including certification to provide Integrated SUD, MH and Primary Care services Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Behavioral Health New York City – IPA Health First, Fidelis, Amerigroup    
Camp Venture, Inc. Marie Pardi, CPO 845–624–5324 marier@campventure.org   Rockland County, NY Camp Venture, Inc. provides services to individuals with Developmental Disabilities. We offer day habilitation services, respite services, employment services, community habilitation services and residential services. Unsure        
Cancer Resource Center of the Finger Lakes Marilee Murphy 607–277–0960 marilee@crcfl.net www.crcfl.net Tompkins and surrounding counties (Cayuga, Tioga, Cortland, Schuyler, Chemung) Create a community of support for those individuals/families touched by cancer. Services include support groups, one on one support, wellness information and education, transportation to appointments, gas cards, and some financial assistance Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Capital District Center for Independence Inc. Laurel Kelley 518–459–6422 laurelk@cdciweb.com www.cdciweb.com Primarily Albany and Schenectady, but also serve consumers in Rensselaer, Columbia, Saratoga, Schoharie, Fulton and Montgomery Our Center has over 40 years´ experience providing direct independent living services to people with disabilities. Services provided include a range of advocacy and self–help instruction, which includes a peer–based approach to managing one´s affairs, the development of self–determination, decision–making skills, self–advocacy skills, assistance in day–to–day community participation, and other social roles. Staff assist consumers in addressing many social determinates of health. For example to address economic stability staff assist consumers to find employment, secure housing, food and other social and community resources to increase their finance independence. Staff assist in addressing other social determinants of health including health and healthcare, economic stability, social, family and.community. We assist consumers with health literacy, accessing appropriate healthcare, finding employment, securing food and shelter, promote social cohesion, civic participations, and various other social and community resources to increase independence. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks CBO Consortium of Upstate New York CDPHP, MVP, Fidelis, New York Quality Healthcare, United Healthcare    
Catholic Charities Mary–Margaret Pekow (315) 598–3980 mmpekow@ccoswego.com www.ccoswego.com Oswego work with adults and children w MH dx and with low income and those in poverty––assist wit lknage and referrals &case management services Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers   Fidelis and Optimum (UHC)    
Catholic Charities Care Coordination Services Stephanie Lao 518–449–3581 stephaniel@ccalbany.org http://www.carecoordinationcc.org/ Albany, Columbia, Greene, Rensselear, Schenectady, Saratoga, Schoharie, Fulton, Montgomery, Otsego, Delaware, Warren, Washington Health Home Services, Harm Reduction Services for individuals with active or history of substance use– including low threshold services for IV drug users (syringe exchange, OOPT) Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers Capital Behavioral Health Network CDPHP, Fidelis, MVP    
Catholic Charities Community Services Lori Van Auken 585.339.9800 Ext 225 lori.vanauken@dor.org   Monroe, Wayne, Steuben, Chemung, Schuyler, Livingston, Seneca, Ontario, Tompkins, Tioga, Yates, Cayuga Care coordination, Children and Adult Health Homes, Home and Community Based, Services, Developmentally Disabled, HIV/AIDS services for Housing, Peer Support, Health Education, Case Management, Medical Transportation, Employment Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Your Health Partners of the Finger Lakes (Behavioral Health Care Collaborative) Excellus Fidelis MVP
Catholic Charities Neighborhood Services, Inc. Claudia Salazar 718–722–6065 claudia.salazar@ccbq.org   Kings and Queens CCNS provides food pantries, assistance with rent and utilities, employment assistance, low income housing and housing support, needs assessments and referrals, behavioral health (mental & SUD) treatment, medical health via nurses and linkages to other providers Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Founding member of CBC and IPA member Healthfirst Beacon Fidelis
Catholic Charities of Buffalo, New York, Inc Marie Andersen–Strait (716) 218–1400 marie.andersen–strait@ccwny.org   Erie, Niagara, Chautauqua, Cattaraugus, Allegany, Orleans, Wyoming and Genesee The agency is unique to provide the essential components related to economic stability, neighborhood and physical environment, education, and food security to better outcomes. Catholic Charities provides an array of comprehensive programs such as basic emergency financial assistance; food, clothing and basic needs assistance; housing, clinical and chemical dependency and support services; school based services; workforce development services; care coordination; immigration/refugee assistance and an array of programs that address prevention and treatment of various family needs. CC is guided by the principles from solution focused trauma informed care to further the enhancement of engagement and empowerment of clients. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Value Network; WNYICC      
Catholic Charities of Chemung/Schuyler Chuck Nocera 607 734–9784 extension 2229 chuck.nocera@dor.org   Chemung and Schuyler Counties Medicaid managed care, HCBS services, permanent supported housing, homeless shelter, homeless prevention services, runaway and homeless youth program, emergency supports (food, clothing, assistance with benefits/Medicaid enrollment, prescription assistance), domestic violence services, and regional health literacy training. Target populations: those in poverty, those who are homeless and those with a serious mental illness or substance use disorder. Provide referrals to a robust network of providers (including physical and behavior health) and services. Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers   NY Quality Healthcare UnitedHealtcare  
Catholic Charities of Chenango County Amanda Erickson (1607334) 824–4228 aerickson@ccofcc.com www.ccofcc.com Chenango Catholic Charities of Chenango County is a regional leader in human and social services, providing an array of programming to support the needs of those who are most vulnerable. CCofCC has substantial experience in providing programs and services related to poverty reduction, healthcare, housing, crime/violence, residential habilitation, residential rehabilitation, community and congregate respite, community habilitation, counseling, food security, job skills development, benefit and entitlement coordination, Medicaid service coordination, care coordination, nutrition and many additional types of programing. CCofCC also serves all demographic types through these programs such as people with mental illness, people with developmental and/or intellectual disabilities, adults, children, elderly, Medicaid recipients, people living in poverty, homeless, unemployed and under–employed, uninsured/under–insured as well as many others. Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers   Fidelis United Health Care Excellus
Catholic Charities of Orange, Sullivan & Ulster John Lent (845) 294–5124 john.lent@cccsos.org www.cccsos.org Orange, Sullivan & Ulster Food pantry, eviction prevention, utility cutoff prevention, and other basic needs assistance for individuals with a financial need Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency CBHS Inc https://www.cbhsinc.org/ & PWR IPA Affinity MVP Wellcare
Catholic Charities of the Diocese of Albany Jackie Gentile (518) 453–8457 jackie.gentile@ccrcda.org ccrcda.org Albany, Rensselaer, Schenectady, Saratoga, Warren, Washington, Columbia, Greene, Schoharie, Otsego, Delaware, Fulton, Montgomery, Herkimer impovershed, disabled, reentry, childcare, homeless, pregnant and parenting teens, care coordination, senior services Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Alliance for Better Health, Capital Behavioral Health Network Fidelis Care CDPDP Empire
Catholic Charities of the Diocese of Rochester, DBA Catholic Charities Livingston County Amy Patterson (585) 658–4466 amy.patterson@dor.org www.aboutcclc.org Primarly Livingston Coumty; however, Livingston also serves Steuben County for Health Home Care Management Services. CCLC provides emergency services such as assistance with rent, security deposit, utility payments, to help people remain in their home. We also help with transportation needs providing bus passes. Further, we help with food through our food pantry. Lastly, we assist with finding employment, transitional jail services, referall for health insurance enrollment, emergency housing, children´s health home, adult home and community based services. Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers   Excellus    
Catholic Charities of the Finger Lakes Ellen Wayne (315) 789–2235 ellen.wayne@dor.org www.catholiccharitiesfl.org Ontario, Seneca, Yates and Cayuga housing/homeless assistance, peer support, emergency assistance, congregate meal, family support, SSI application assistance Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Catskill Center for Independence Meghan Staring 607–432–8000 meghanstaring@ccfi.us www.ccfi.us Delaware, Otsego, Chenango, Schoharie Serve people with disabilities Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers        
cattaraugus & wyoming counties project head start ira katzenstein (716) 806–5128 ikatzenstein@headstartnetwork.com www.headstartnetwork.com cattaraugus, wyoming health education for low income parents Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Cayuga Addiction Recovery Services Frank Zdanowicz, Chief Financial Officer 607–273–5500 Ext. 1046 fzdanowicz@carsny.org www.carsny.org We serve all counties in New York State as needed. The caring team at Cayuga Addiction Recovery Services uses evidence–based techniques to help people overcome the disease of addiction. The staff, consisting of experienced social workers, nurses, and counselors, build respectful partnerships with patients and their families and work hand–in–hand with them to transform their lives. We have an Outpatient Addiction Recovery Center in Ithaca, NY and a 60–bed Residential Addiction Recovery Center in Trumansburg, NY. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Integrity Partners and AHP (Accountable Health Partners) Fidelis Excellus Beacon/MVP, United Healthcare, Molina, CDPHP
Cazenovia Recovery Systems Ed Cichon (716) 852–4331 ecichon@cazenoviarecovery.org   Erie and Niagara Residential substance use treatment and support services Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Affiliate member of Value Network IPA, member of the Niagara County Behavioral Health Network IPA, and a member of the WNY Chemical Dependency Consortium Fidelis YourCare Independent Health
Center for Comprehensive Health Practice Thomas Nicolich 212–360–7781 tnicolich@cchphealthcare.org www.cchp.org New York Treatment for Substance Use Disorders, Primary Health Care Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   Metro Plus Health First Fidelis
Center for Family Life – SCO Family of Services Heath Bloch (1516) 953–1920 hbloch@sco.org https://sco.org/featured–programs/center–for–family–life/ Kings Center for Family Life (a program of SCO Family of Services) provides comprehensive programs in youth development, employment, education, counseling, foster care, arts, and recreation and engages more than 14,600 children and adults from 10,500 families each year. Unsure        
Central Nassau Guidance & Counseling Services Nancy Manigat (516) 396–2819 nmanigat@centralnassau.org www.centralnassau.org Nassau; Suffolk CN Guidance & Counseling Services provides integrated behavioral & physical health treatment and support services. Our PROS, ACT, Health Home, HCBS Adult Waiver and Housing services adults with serious mental illness and all have components that address the SDH impacting the individual´s ability to function independently in the community. Our Certified Community Behavioral Health Clinic treats children, adolescents and adults with wrap around services such as targeted case management and psychiatric rehabilitation that address the SDH. Our OASAS COTI Mobile Recovery Unit services adults with opioid use disorders and has a case management component that addresses the SDH impacting the individual´s recovery. The Starry Night Café services adults with IDD or MH that focuses on improving social supports. Registered nurses are impeded in most of our programs to improve health literacy. We also have food pantries on site for our clients. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Recovery Health Solutions: https://recoveryhealthsolutions.com/; Advanced Health Network: https://www.ahn–ipa.com/ Affinity Health Plan, Inc./ Beacon    
Centro Corazon de Maria MARY E. MOORE (631) 728–5558 corazondemaria2@gmail.com in process Suffolk, NY We work with Latino immigrants, many of whom do not speak English and are undocumented. However their children are citizens. We work individually with persons who use hospital E. R. services to connect them with emergency Medicaid. We also do referrals to providers for children. We partner with Sepa Mujer for a wide range of services to women. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Fidelis    
Champlain Valley Family Center for Drug Treatment and Youth Services Constance Wille 518–561–8480 cwille@cvfamilycenter.org cvfamilycenter.org Primarily Clinton, some service in Franklin and Essex Counties (Tobacco Free Clinton, Essex and Franklin Counties) Champlain Valley Family Center (CVFC) provides an array of services focused on Substance Use prevention, education, treatment and support services. Services include: Community Education, school based prevention counselling and evidenced base curriculum delivery, 822 Outpatient clinic, 820 Residential SUD Stabilization and Rehabilitation, "All Ways to Recovery" Community Center, Peer Engagement Services, SUD services in Clinton County Jail, MRT/PSH Housing, Adolescent Case Management, Tobacco Free Clinton, Essex and Franklin Counties, Adolescent Case management, CVFC is in the process of onboarding for Health Home Care Management (AHI). Community Education focuses on Substance Use Disorders, Bridges Out of Poverty, and Trauma Informed Care. Depending on the audience, other trainings are available. The majority of clients admitted in the clinic and the residential center have multiple diagnosis in addition to SUD. Social Determinants of health are evaluated during the assessment process and adressed during the course of care. CVFC provides Peer Engagement Services to CVPH hospital, Clinton County DSS, NYS Department of Community Supervision, and outpatient clinics. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Northwinds Integrated Health Network IPA Fidelis Care    
Chautauqua Striders, Inc. Jennifer Swan–Leuze 716–489–3488 jswanleuze@chautauqua–striders.org www.chautauquastriders.org Chautauqua Tutoring, Mentoring and Life Skills Education Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
CHDFS, Inc Julio Barros 212–695–4562 jbarros@chdfs.org www.chdfs.org NYC, Lower Hudson Valley 1115 Waiver, Health Homes, Early Intervention, OPWDD Waiver Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   Several    
CHDFS, Inc Julio Barros 212–695–4562 jbarros@chdfs.org www.chdfs.org NYC, Lower Hudson Valley 1115 Waiver, Health Homes, Early Intervention, OPWDD Waiver Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   Several    
Chenango Health Network, Inc Theresa Davis (1607) 337–4128 theresa@chenangohealth.org http://www.chenangohealth.org Chenango & Delaware • Cancer Support Group – A group of individuals with common experiences or concerns who provide each other with encouragement, comfort, and advice. • Care Transitions/Health Coach (based on the Coleman Model) – Involving the patient and family in discharge planning can improve patient outcomes, reduce unplanned readmissions, and increase patient satisfaction. The goal is to reduce 30–day avoidable hospital readmissions. • Chenango Substance Abuse Prevention Coalition (CSAPC) – The mission of the Coalition is to bring individuals and organizations together to promote a clean, safe, and addiction–free community. • Chronic Disease Self–Management Programs (CDSMP), Diabetes (DSMP) Chronic Pain (CDSMP) – workshops designed to help people gain self–confidence in their ability to control their symptoms and learn how their health problems affect their lives. • Community Based Education Services – The purpose of community learning and development is to develop the capacity of individuals and groups of all ages through their actions, the capacity of communities, promote learning and to improve their quality of life. • Community Health Advocate Program – Community Health Advocates assist individuals with a wide range of health related issues from finding a health care provider to understanding medical bills. • Dental Project – This initiative provided a dental kit to each student in Chenango County up to fifth grade. The dental kits included a toothbrush, toothbrush cover, toothpaste, floss and educational materials on proper brushing techniques. • Emergency Department Navigation Services – A Case Manager educates patients on how to access health care and other needed services such as transportation to medical appointments, and provides patients with the skills and tools needed to assert a more active role in their care and ensure their needs are met • Financial Assistance Program – Assists individuals with a breast or gynecological cancer diagnosis pay for treatment and/or other needs related to their cancer diagnosis. • Health Insurance Navigator Assistance Program – Trained Navigators assist individuals to apply for health insurance through the New York State of Health Insurance Marketplace. • Referral Services – The process of transferring and individual to another service within CHN or to another agency, service or program not provided by CHN. • Prescription Assistance Program – Assists individuals with enrollment into pharmaceutical companies´ patient assistance programs so that medically underserved individuals are able to obtain medicines needed to manage their health. • Youth, Adult, Fire & EMS Mental Health First Aid – is a public education program that introduces participants to risk factors and warning signs of mental health problems in adolescents. The program builds understanding of the importance of early detection and intervention. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Excellus Health Plan, UnitedHealthcare of NY MVP Health Plan, Inc NY Quality Healthcare Corporation
Child & Family Services Gretchen Szymanski 335–7154 gszymanski@cfsbny.org www.cfsbny.org Erie and Niagara Child & Family Services provides mental and behavioral health services to youth, families, and adults to promote healthy families and communities. Services include, but are not limited to, out–patient and community mental health, residential services, family support services (e.g. Health Homes). Targeted populations include individuals from birth through adult with mental and behavioral health challenges. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   Fidelis, Independent Health Association, Your care    
Children´s Aid Jaime Huertas 212–503–6808 jaimeh@childrensaidnyc.org Childrensaidnyc.org New York, Bronx, Richmond At risk Children and Families, Children in Foster Care Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency AsOne Healthcare IPA Healthfirst    
Children´s Home of Jefferson County Michelle Monnat 315–777–9747 mmonnat@nnychildrenshome.com http://nnychildrenshome.com/ Jefferson, Lewis, St. Lawrence, Franklin, Onondaga, Oneida, Oswego, Clinton, Herkimer, Essex OMH Article 31, Health Home Care Management for Adult and Children, Adult HCBS, CFTSS, Foster Care, Crisis, Forensics Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency North Country Initiative IPA United Healthcare, Fidelis and MVP    
Chinese–American Planning Council, Inc Steve Mei (718) 492–0409 smei@cpc–nyc.org www.cpc–nyc.org All five boroughs of New York City CPC offers a variety of services from child care to senior services, and everything in between. CPC Brooklyn offers services to our Special Needs community members, Geriatric Mental Health Services, and all walk–in services( including access to healthcare, housing, employment, translation, legal services, language access, etc) Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Citizen Advocates James Button, COO 518–651–2245 jamesbutton@citizenadvocates.net citizenadvocates.net Franklin, Clinton, Essex, St. Lawrence, Hamilton Mental Health; Addiction prevention, treatment & recovery; Intellectual & Developmental Disability Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Northwinds Integrated Health Network, IPA Fidelis    
City Mission of Schenectady Erin Simao 518–346–2275 x 406 esimao@schenectadyworks.com citymission.com Schenectady emergency shelter, transitional housing, food, clothing, job search and career readiness, health care and social services navigation Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks Healthy Alliance IPA Fidelis, CDPHP    
Claxton Hepburn Medical Center Kelley Tiernan (315) 713–5350 ktiernan@chmed.org chmed.org St. Lawrence County, Jefferson County, Franklin County We provide Diabetes and Nutritional Counseling, we have a language line service, we have facilitated enrollers on site for access to Healthcare. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency North Country Initiative (northcountryinitiative.org) Fidelis    
Clinton County Chapter NYSARC, Inc Lorraine Lobdell 518–563–0930 llobdell@cviarc.org cviarc.org Clinton, Essex, Franklin, St. Lawrence, Jefferson OPWDD provider for individuals with ID/DD, supervised residential homes, day habilitation, prevoc, transportation, employment, clinical/behavioral/nursing supports and Fiscal Intermediary services are provided to a mix of residents and community people authorized for OPWDD services. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency        
Clinton County Mental Health and Addictions Richelle Gregory 518–565–4068 richelle.gregory@clintoncountygov.com https://www.clintoncountygov.com/mental_health_addiction_services Clinton Vocational Services On–Site, Grant to address Nutions and Food Security with CC Helath Department, Transportation for the SUD population, DIR on site, Healthy Steps Grant Partnership, Integrated Services in Primary Care (Pediatric and Adult), Certification in Infant Mental Health, Peer Services on Site , Mental Helath and Addictions Services in Jail, Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Northwinds IPA Fidelis    
Collaborative for Children & Families Jodi Saitowitz 646–459–3971 jsaitowitz@ccfhh.org   All 5 Boroughs of NYC, Nassau, Suffolk and Westchester Health Home Care Coordination Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers AsOne HealthFirst Empire Affinity
College Initiative Upstate (a Program of O.A.R. of Tompkins County) Suzanne Burnham 607–882–0355 collegeinitiativeupstate@gmail.com www.ciutompkins.org Tompkins County A bridge to college for formerly incarcerated, court involved and prior court involved individuals. No age requirement. Must be a HSD or GED/TASC holder. Offering direct services such as: assistance with college application, assistance with FAFSA and TAP. Scholarships, 6 week long college prep classes, and more! Unsure   CHP Medicaid  
Comfort Food Community Amelia Gelnett 518–530–9299 amelia@comfortfoodcommunity.org   Washington, Warren, Saratoga We address food insecurity, social isolation, health and community resource connection, and individual nutritional support. Our target population is low–income individuals experiencing chronic illnesses. We have developed a Fresh Food Collective which integrates social agencies, food pantries, libraries, and a local FQHC to distribute local produce. We run a Fresh Food Farmacy which targets diabetes, hypertension, and other conditions in the Medicaid and Medicare populations in partnership with Hudson Headwaters Health Network. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Fidelis CDPHP Humana
Community Action of Greene County, Inc. Florence Ohle (518) 943–9205 fohle@cagcny.org www.cagcny.org Greene/Columbia housing and homelessness, emergency services, food pantry, financial empowerment, victim assistance and domestic violence Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Community Agency for Senior Citizens, Inc. Angelina DeSantis 718–981–6226 x170 angelina.desantis@cascsiny.org https://cascsiny.org Richmond CASC serves older adults, 60 yrs and older and residents of Staten Island. Services incl case managment, case assistance with entitlements and benefits applications, transportation, nutrition, arts, edducation, recreation and socialization at 2 neighborhood senior centers, elder abuse and crime victims assistance. CASC partners with other local & city/state agencies working in aging, health, social sevices, law enforcement and legal seervices/agencies. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Community Based Services, Inc. Dr. Pela S. Terry, Ed.D. 914–277–4771 pterry@commbasedservices.org www.commbasedservices.org Westchester, Putnam, Dutchess Medicaid Waiver: Home and Community Based Services via DOH/OPWDD Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Hudson Valley Service Providers, LLC (provider membership LLC;IPA application is pending) MCAID Affinity MVP
Community Concern of WNY Valerie Nowak 716–947–5025 vnowak@communityconcern.org   Erie, Chautauqua, Cattaraugus Behavioral heath services (13 and over), health home services (21 and over), senior services (60 and over) Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Value Network HealthNow Independent Health YourCare
Community Health Center of Richmond Benito Lindo (718) 924–2254 jyandun@chcrichmond.org www.chcrichmond.org Richmond County The Community Health Center of Richmond provides affordable, quality health care and coordinated access to specialty services to the Staten Island community. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   Medicaid, Medicare, All HMO´s, Child Health Plus    
Community Maternity Services Anne Marie Couser Tom Giaquinto annemarie@cccms.org www.cccms.org Albany, Rensselaer, Saratoga, Warren, Washington, Schoharie, Otsego, Schenectady Residential services for pregnant and parenting youth and you 0–18 with special needs; foster care prevention services; parent education, community based case management for pregnant and parenting adolescents; community based respite services for children ages 5–18 in Albany County only; school based counseling services in Albany, Adult Care management services in Warren & Washington counties. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   CDPHP Fidelis  
Community Progress, Inc. Julie Chevalier (607) 962–3506 juliec@communityprogressinc.com www.communityprogressinc.com Chemung, Schuyler and Steuben CPI provides home repair assistance for homeowners, this includes addressing lead, asbestos and radon issues. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Unknown    
Community Resources (CRIS) Karisha Solomon (315) 655–5743 director@cris–caz.com www.cris–caz.com madison senior services Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Community Services for Every1 Sharon Chmielnicki 716–883–8888 schmielnicki@csevery1.com www.csevery1.com Mostly Erie and Niagara County, for some services are able to do so in most WNY Counties Majority of our services are OPWDD serving the I/DD population. Additionally, we provide Children and Adult Health Home Case Management and HCBS Services, Preventive Services, High Fidelity Wrap Services, Alternative to Incarceration Services, Employment Readiness and Training for a variety of populations. We also own and operate several affordable housing apartments. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency        
Compeer Rochester Sara Passamonte 585–546–8280 spassamonte@compeerrochester.org   Monroe 1:1 Mentoring, Psychosocial Rehab for children and adults, Habilitation for adults, Family Peer Support, Family Caregiver Support and Training for family members of youth and adults, Youth Peer Support, Adult Peer Support Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers we are part of a Behavioral Health Care Collaborative that may become an IPA in the future– Your Health Partners of the Finger Lakes Excellus Fidelis FFS Medicaid
Comunilife Beverly Raudales (917) 500–2906 braudales@comunilife.org www.comunilife.org Kings, Manhattan, Bronx, Queens Supported and Affordable Housing for Mentally, Chronically Homeless, low income, individuals; also provide temporary housing to individuals currently hospitalized are medically cleared but do not have housing via our Respite Program Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   MetroPlus, United Health Care, Healthfirst    
Consortium for Children´s Services Kathleen Harter (315) 471–8331 KHARTER@CHILDRENSCONSORTIUM.ORG www.childrensconsortium.org Onondaga, Cortland, Cayuga, Oswego, Madison Parenting education for at–risk families Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Crouse Hospital    
Consumer Credit Counseling Service of Buffalo, Inc. Noelle Carter (716) 771–3255 noelle.carter@cccsbuffalo.org www.consumercreditbuffalo.org Niagara, Erie, Chautauqua, Cattaraugus, Allegany, Wyoming, Genesee, and Orleans. Financial education and counseling Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
COORDINATED BEHAVIORAL CARE IPA, INC. Sara Belly Sezer (646) 930–4784 ssezer@cbcare.org \http://www.cbcare.org/ Bronx, Kings, Queens, New York, Richmond, Through Health Home and Network Provider agencies, CBC connects clients to a range of services for the entire spectrum of life. Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers Coordinated Behavioral Care IPA      
Cornell Cooperative Extension of Herkimer County Linda Robbins (315) 866–7920 LLR6@cornell.edu www.cce.cornell.edu/herkimer Herkimer County Nutrition education programs for low income families (see website) Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   CHP, COMM, HARP, MCAID    
Cuba Cultural Center, Inc. Suzanne Flierl Krull, Executive Director (585) 376–4583 Suzanne@cubaculturalcenter.org www.cubaculturalcenter.org Allegany and Cattaraugus Counties We provide survival programs for poor, low–income, oppressed and otherwise marginalized individuals and families. We offer several food security programs & serve on area coalitions (food, housing and homeless, and suicide prevention). Our ED serves as a board member of the HUD 501 Continuum of Care, and the Hunger Action Network of NYS. She is also a member of the Coordinating Committee of the NYS Poor People´s Campaign: A National Call for Moral Revival, which continues the human rights work called for by Dr. King back in the 60s. We are also developing a Speakers´ Bureau of people impacted by hunger and poverty, to advocate for themselves personally and for others in their community in a variety of ways. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Developmental Disabilities Institute, Inc. Kim Kubasek 631–366–2965 kim.kubasek@ddiny.org www.ddiny.org Suffolk and Nassau Educational services (early intervention and preschool through school age) and long term services and supports (residential habilitation, day habilitation, vocational services, etc.) for children and adults with autism and other developmental disabilities. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency        
Diaspora Community Services Carine Jocelyn (718) 399–0200 cjocelyn@diasporacs.org www.diasporacs.org Kings Health insurance enrollment, HIV services, case management, food stamp assistance, homeless housing for youth. linkage to services, care Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers Engagewell MetroPlus, Fidelis, HealthFirst,    
Docs for Tots Liz Isakson 917.318.4201 liz@docsfortots.org   Nassau and Suffolk Help Me Grow – Long Island serves families with children prenatal to age 5. It is a centralized access point that connects families to a wide array of service that support child development, – everything from basic needs to developmental interventions. It also offers free development and social emotional screening to families. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Dominican Women´s Development Center Rosita Romero (212) 994–6060 Rromero@dwdc.org Dwdc.org New York Care coordination, home visiting early childhood education, pantry with the West Side Campaign Against Hunger, New York State of health insurance enrollment Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Health first    
E. John Gavras Center Danielle Wright (315) 255–2746 dmw@gavrascenter.com www.gavrascenter.com Cayuga, Onondaga, Tompkins, Wayne, Seneca Early childhood education, Article 28 clinic Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   Excellus    
Economic Opportunity Council of Suffolk, Inc. Halim Kaygisiz (631) 241–2119 hkaygisiz@eoc–suffolk.com   Suffolk AND Nassau Counties Financial assistance for rental and utility arrears (in–house when funds are available and through partnerships at other times), food pantry services (both in–house and through partnerships), transportation services (for HIV–positive clients), social service navigation for benefits, workforce readiness and development (via partnerships), child care, re–entry services for formerly incarcerated indivdiuals, access to health care, access to PCP/infectious disease care; health literacy, crime and violence Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers   Affinity Fidelis United Health Care
ElderChoice Inc. Rei Thompson 315–252–7889 rthompson@elderchoiceinc.com elderchoiceinc.com Onondaga County and Oneida County PCA services including Medicaid Waiver, TBI, NHTD Unsure        
ElderLife, Inc, dba Parkway Center Kari Johnson 315–223–3973 ext.117 kjohnson@theparkwaycenter.org www.theparkwaycenter.org Oneida and Herkimer The Parkway Center´s mission is to provide programs and services to individuals 50+ empowering them to live healthy and vibrant lives. The services being provided include: health, wellness, and nutrition; transportation; education; arts/music; social/recreation; financial independence; volunteer services; veteran services; and access to resources. All of the Parkway Center´s services provide programs that help seniors remain active and independent as they age. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks Upstate CBO Consortium Excellus BC BS MVP CDPHP
Empower (formerly Niagara Cerebral Palsy) Eric DesSoye 716 803–2184 edessoye@empower–wny.org empower–wny.org Niagara Empower provides a full array of supports for people with Intellectual and Developmental Disabilities, as well as elders, and pre–k aged children. The services we provide either directly provide those items checked in question 5, or facilitates their presence in the lives of people we support. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Western New York Integrated Care Collaborative, and CBO Consortium of Upstate New York      
Endeavor Health Services Kristin Kight (17168956) 700–4085 kkight@ehsny.org https://www.ehsny.org Erie, Niagara, Orleans, and Monroe counties HCBS, TCM, HH, MAT, CFTSS, PROS, PSR, Advocacy, School–based Clinics, and Behavioral Health Integrated Clinics Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Value Network Fidelis, Excellus Health Plan, HealthNow of New York, Independent Health Association    
EPIC Family of Human Service Agencies Jennifer Colbert 516–739–7733 ext. 400 jcolbert@epicli.org www.epicli.org Nassau, Suffolk, Westchester, five boroughs of NYC, Orange, Ulster, Dutchess, and Sullivan Mental health, substance abuse prevention, services for intellectual and developmental disablitlies including residential, community habilitation and day habilitation, mobile crisis, home based crisis intervention, and CFTSS services Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency ACA,COPA, IAC Health First Fidelis Care United Health Care
Erie County Bar Association Volunteer Lawyers Project Bob Elardo (716) 847–0662 relardo@ecbavlp.vom ecbavlp.com Allegany, Cattaraugus, Cayuga, Chautauqua, Chemung, Erie, Genesee, Livingston, Monroe, Niagara, Ontario, Orleans, Schulyer, Seneca, Steuben, Tioga, Tompkins, Wayne, Wyoming, Yates Providing free civil legal services to low income individuals, including individuals and families affected by HIV/AIDS Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Independent Health, Excellus    
Esperanza Center Yesenia Estrella (212) 928–5810 yestrella@esperanzacenter.com esperanzacenter.com Manhattan, Bronx Organization provides day and residential services to people with developmental disabilities. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency        
Essex County Mental Health Terri Morse (518) 873–3670 tmorse@co.essex.ny.us http://www.co.essex.ny.us/MentalHealth.asp Essex Behavioral Health services, psychiatry – children and adults; telemental health; case management; trauma–informed treatment; groups therapy; CFTSS; early childhood mental health; mental health treatment in the county jail. Target populations – all citizens of Essex County Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Northwinds Integrated Health Network, IPA Fidelis United Health Care CDPHP
Essex County Public Health CHHA JENNIFER M NEWBERRY (518) 873–3710 jnewberry@co.essex.ny.us www.essexcounty.ny Essex Home Health Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Evergreen Health Melissa Gulino (716) 847–2441 mgulino@evergreenhs.org evergreenhs.org Allegany, Erie, Niagara, Chautauqua, Cattaraugus, Orleans, Genesee, Wyoming Care Coordination, Social Work and Medical Case Management Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Safety–Net IPA (SIPA) and Value Network Fidelis    
Every Bottom Covered Raziya Hill (716) 597–2303 raziyahill@everybottomcovered.org www.everybottomcovered.org Erie, Niagara Providing hygiene basic needs to low–income families, workshops for family sufficiency, resources to other community based organizations that assist low–income families Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks CBO Consortium http://www.cboconsortium.org/ Excellus Health Plan, Inc. WellCare of New York, Inc. YourCare Health Plan, Inc., UnitedHealthcare of New York, Inc., New York Quality Healthcare Corporation, Independent Health Association, Inc., HealthNow of New York, Inc.
Faith in Action Steuben County Richard Russell (607) 324–1138 rrussell@fiasteuben.org www.fiasteuben.org Steuben Medical and nutritional transportation for older adults (60yo+) Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks CBO Consortium of Upstate NY, http://www.cboconsortium.org/      
Families First in Essex County, Inc. JoAnne Caswell (518) 546–3569 jcaswell@familiefirstessex.org   primarily Essex, but also Clinot, Franklin, Warren & Washington CFTSS & HCBS Services along with HH Care Manangement and NYS OMH Family and Youth Support, 0–21 target population, transporation, housing support, food Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers Northwinds Integrated Health IPA Fidelis    
Families on the Move Inc. Ravi Ramaswamy 347–682–5490 ravi@fotmnyc.org Families on the Move Inc. All boroughs of New York City CFTSS, HCBS awell as Family and Youth advocate support in South beach children´s hospitaladvocates for the Astor case management program and Family and youth peer support for the South Beach children´s hospital Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers   Healthfirst, Affinity,Wellcare    
FAMILY AND CHILDREN´S ASSOCATION LISA BURCH (516) 746–0350 lburch@fcali.org www.fcali.org Nassau, Suffolk SUD, CFTSS, HCBS Waiver, food pantry, co–op nursery, vocational–educational, ESL/GED, Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Recovery Health Solutions Health First, Fidelis, United Healthcare    
Family Care Certified Services Kesha Yansen 718–570–6815 kyansen@familyhomecare.com familycarecertifiedservices.com Kings, Queens, Nassau, Bronx, Westchester, Putnam, Dutchess, Homecare services, Skilled services (Nursing, Physical & Occupational Therapy, Medical Social Services), Para–professional Services (Home Health Aide, Personal Care Aide) Unsure   Healthfirst United Health Care Emblem Health
Family Counseling Service of the Finger Lakes Cathy Thurston 315–789–2613 x2115 cthurston@fcsfl.org www.fcsfl.org Ontario, Seneca, Wayne, Yates Trauma–informed care in Counseling/therapy and asessment; advocacy related to crime victims support and accessing resources Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks CBO Consortium of Upstate New York      
Family Reading Partnership Amber Smith (607) 277–8602 amber@familyreading.org http://www.familyreading.org/ Tompkins County We partner with WIC to give all who are entering the program a new book. Read Along Love Songs with Baby goes to the Mom´s Program which include books that are also songs, this collection also comes with a CD of recordings of the songs. Our Talk, Sing, Read, Play with Me collections comes with materials to promote positive interactions between the caregiver and the baby, this collection is for families in rural places in Tompkins county. Our Books To Grow On Program provides a book to every child going to a well visit until they are 4 years old in Tompkins County. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks We are a legally formed CBO      
Family Residences and Essential Enterprises, Inc Matthew Collins 516–870–1600 x1862 mcollins@familyres.org   Suffolk, Nassau, Queens, Staten Island Behavioral Health, Housing, Entitlements, Employment Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency AHN/RHS United Healthcare Beacons Health First
Family Resource Center Theresa Wilkins (315) 402–0151 ed@familyresourcecenter.life www.familyresourcecenter.life Oswego We provide free pregnancy testing, free parenting classes and free material items such as diapers, wipes, baby formula, baby clothes and more when clients take parenting classes. We help any parents in Oswego County that would like to work with us; this includes single parents and couples. Clients who do not have custody or visitation of their children may also work with us to be pro–active in gaining visitation. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Family Service Association of Glens Falls, Inc. Kim Sopczyk 518 793 0797 150warreb@albany.twcbc.com www.fsaglensfalls.org Warren, Washington, Northern Saratoga We work with families and individuals who are facing a situation that is beyond their resources: food insecurity, housing needs, transportation needs, emergency RX, budgeting programs, and support to move forward out of crisis. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Family Service League, Inc Jeff Steigman 631–470–6790 jsteigman@fsl–li.org http://www.fsl–li.org/ Suffolk FSL has many safety net programs that address SDH. These service include assistance with benefits, housing (we have several housing programs including family shelters), food insecurity, vocational educational goals Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Advanced Health Network/Recovery Health Solutions United Healthcare Affinity Healthfirst
Family Services Robin Peritz 845–486–2703 x 1325 rperitz@familyservicesny.org familyservicesny.org Dutchess, Ulster and Orange Counties Family Services has been bringing people together to find the port they need improving their lives and communities, and building a stronger, safer Hudson Valley. We offer a wide range of programs in the areas of: Behavioral Health, Victim Services, Family Programs, Youth Services, Community Safety, and Prevention. Last year, over 17,500 children, adults, and families benefited from our services in Dutchess, Ulster and Orange counties.Through our programs, families, adults, teens and children overcome trauma, addiction, violence, unemployment and isolation. We offer after–school programs for K – 12 youth, providing young children with activities in a safe environment to enhance their academic, life and social skills; and helping teens to find meaningful work, stay active and fit, be creative and discover connections to their talents. We support and nurture those who have been victimized and provide 24–hour crisis assistance to help those impacted by domestic violence, sexual assault and other crimes. We ensure access to high–quality individual and group therapy and support those with behavioral health needs to carry on safely through their most challenging times. We provide critical support to stabilize families and ensure child safety. We help communities become safer and foster communications that yield positive results. We are regional leaders in programming that increases individuals´ awareness and coping skills to reduce sexual violence, gun violence, and substance abuse. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency CBHS Beacon Health Options, Fidelis, Wellcare    
Family Services Network of New York, Inc. Benjamin Igwe 718.455.6010 x 6101 bigwe@fsnny.org www.fsnny.org Kings, Queens, New York, Bronx, Richmond FSNNY provides health and human services to individuals and their families with chronic health, mental health and substance use disorders through prevention education, counseling and case management to improve their conditions. These services assist the individual to obtained those social and human services necessary to access and stabilize their chronic medical or mental health treatment. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Engagewell IPA www.engagewellipa.com Metroplus, Healthfirst, affinity    
Family Ties of Westchester, Inc Kerry Whelan–Megley (914) 995–5238 kmegley@famtieswest.org www.familytieswestchester.org Westchester County, NY Community–based Family and Youth Peer Support and advocacy services, including CFTSS and HCBS Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers Affiliate member of CBHS      
Famiy Services of Chemung County, Inc. David Crist 607–733–5696 dcrist@familyservices.cc   Chemung Our agency operates a Care Management Program for Children and Adults; a NYS OMH licensed Mental HealthClinic and 18 Clinic Satellites providing a full range of clinical services including case management and referral; a NYS OMH licensed Comprehensive PROS with Clinical Treatment, also providing case management and referral; an Adult HCBS Program; a licensed Home Care Program; and ancillary mental health programs including case management and care coordination in the local jail and in the local office for the aging and adult protective services; Care Management for individuals with Eating Disorders; and Representative Payee Case Management Services for Individuals identified with Mental Health challenges. Our Adult Mental Health Programs include Trauma, Sexual Abuse, Sex Offender, Domestic Violence, Anger Management services and coordination with community partners. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Finger Lakes Independent Practice Association (FLIPA); Finger Lakes Southern Tier Behavioral Health Care Collaborative (FLST BHCC) Fidelis Care (NY Quality Healthcare Corp)    
Federation of Organizations Elizabeth Galati (631) 669–5355 egalati@fedoforg.org www.fedoforg.org Queens, Kings, NYC, Bronx, Nassau, and Suffolk Federation provides residential, clinical, outreach, and care coordination that address all areas of social determinants of health. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Advanced Health Network/Recovery Health Solutions and Coordinated Behavioral Care Healthfirst, Fidelis    
Feeding with TLC, Inc. Mary Ciccolella (1917) 582–0161 Maryciccolella@gmail.com Na Richmond County Soup kitchen and dood pantry Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Medicaid    
Finger Lakes Community Health Jennifer Rios–Raner (315) 521–9102 jenrr@flchealth.org www.localcommunityhealth.org Ontario, Seneca, Yates, Wanye, Steuben, Cayuga Community based organization, care coordination, reproductive health, language assistance, HHUNY care mangement, medical services, dental services, most low income Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   Excellus Fidelis  
Finger Lakes Independence Center Rachel Ferrara 607–272–2433 rachel@fliconline.org www.fliconline.org Tompkins, part of schyular, but most programs do not have residence as an eligibility requirement Independent Living skills, housing, benefits advisement, in–home personal care, peer counseling, individual advocacy, equipment loan, systems advocacy, community outreach and education, transition from institutions, employment services, Unsure   Fidelis    
Finger Lakes Land Trust Kelly Makosch 607–275–9487 kellymakosch@fllt.org www.fllt.org Cayuga, Cortland, Chemung, Livingston, Onondaga, Ontario, Schuyler, Seneca, Steuben, Tompkins, Tioga, Yates By working cooperatively with landowners and local communities, the Finger Lakes Land Trust has protected more than 23,000 acres of the region´s undeveloped lakeshore, rugged gorges, rolling forest, and scenic farmland. The Land Trust owns and manages a network of over 30 nature preserves that are open to the public and holds perpetual conservation easements on 138 properties that remain in private ownership. The Land Trust focuses on protecting critical habitat for fish and wildlife, conserving lands that are important for water quality, connecting existing conservation lands, and keeping prime farmland in agriculture. The organization also provides programs to educate local governments, landowners, and local residents about conservation and the region´s unique natural resources. Unsure        
First Chinese Presbyterian of NY Phaiphan Sangtippawan (212) 226–4910 Psangtippawan@fcpnyc.org n/a Manhattan, Brooklyn, Bronx, Queens, Staten Island LHCSA, home care services Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks SOMOS HealthFirst, VNS    
Forestdale, Inc. Lorraine Gonzalez–Camastra 718–263–0740, x281 Lgonzalez–camastra@forestdaleinc.org www.forestdaleinc.org Queens Child welfare case and care mgmt: family preventive services; parenting guidance and support, youth development, integrated health services Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   Unknown    
Fort Drum Regional Health Planning Organization Linsday Baldwin 315.755.2020 lbaldwin@fdrhpo.org www.fdrhpo.org Jefferson, Lewis, St. Lawrence Health Planning Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks CBO Consortium of Upstate New York (http://www.cboconsortium.org/) UnitedHealthcare, New York Quality Healthcare Corporation (Fidelis)    
Fort Greene Strategic Neighborhood Action Partnership Georgianna Glose (718) 694–6957 drglose@fortgreenesnap.org www.fortgreenesnap.org Kings, Queens, Manhattan, Staten Island, Bronx Parenting/Accountability workshops, Health Care Navigation, Access Health, Computer Basics, Resume Preparation, Job Search, Grandparent Care giver Support Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Health First    
Fort Hudson Home Care, Inc. Andy Cruikshank 518–747–2811 acruikshank@forthudson.com www.forthudson.com Warren, Washington, Saratoga, Essex, Clinton, Hamilton home care services, Day services, case management Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency        
Fountain House Nicole Pickett (212) 582–3155 npickett@fountainhouse.org https://www.fountainhouse.org/ Kings, Bronx, Brooklyn, Queens Fountain House is an innovative, evidenced–based community based organization dedicated to improving the lives of individuals with serious mental illness since 1948. Through our Community System of Care, we operate 2 award–winning Clubhouse programs, a housing program that provides all levels of mental health housing supports, a Care Management Agency and Home and Community Based Services. We address a wide array of social determents of health, specializing in employment and education support services, with impressive outcomes accordingly. A recent study has shown, we reduce the costs of Medicaid by 21% for our members. We have a partnership with Bright Point Health, an FQHC that is able to provide quality psychiatric and primary care to our members. Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers CBC IPA Health First, Empire BCBS, MetroPlus, Fidelis Care, Emblem    
Friends of Mariners Harbor Emanuel Bloomfield–Jones (347) 599–5686 Bloomfield.resource@gmail.com http://www.friendsofmh.org Richmond create and maintain impactful programs to enrich the community and local parks. Our goal is to work collectively with the community to develop events while beautifying their neighborhood through community services and art. Unsure        
Gateway Community Industries, Inc. Stephanie Turco (845) 331–1261 sturco@gatewayindustries.org http://gatewayindustries.org Ulster, Dutchess, & Columbia counties Housing, day programs, employment, food, transportation Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers CBHS Network partner Wellcare, Fidelis, United, Beacon/MVP.    
Glens Falls Independent Living Center Operating as Southern Adirondack Independent Living Jocelyn Blanahrd 518–792–3537 jocelynb@sailhelps.org   Warren, Washington, Saratoga, Clinton, Hamilton, Essex, Fulton, Montgomery, Schenectady, and more SAIL provides assistance with benefit and entitlement programs and services that help people live safely in the community. SAIL´s services are targeted at people with disabilities but in particular our connection with health insurance enrollment and problem solving services go beyond services to people with disabilities. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks Healthy Community Alliance CDPHP Fidelis MVP
Good Shepherd Services Katie Blakey–Beisser (212) 381–0225 katherine_blakey@goodshepherds.org https://goodshepherds.org/ New York City– Brooklyn, Queens, Manhattan, Bronx and Staten Island. *GSS provides the following services: After–School and Summer Camp, Supportive Housing, Child Welfare, In–School Supports, Domestic Violence Programs, Community Centers, Health Care Coordination, Workforce Development and Youth Justice. Unsure        
Goodwill NYNJ Gloria Choi 718–777–4209 gchoi@goodwillny.org https://www.goodwillnynj.org Manhattan, Queens, Bronx, Brooklyn and parts of Northern NJ Target populations include individuals with mental health diagnoses, substance use disorders, developemental and learning disorders, spectrum disorders, individuals needing employment, housing, and education supports. Goodwill NYNJ providers job coaching for individuals with disabilities and temporary job placements through our workforce and GoodTemps programs. Employment is a major focus for al individuals treated at various OMH, OPWDD and DOHMH programs. We also offer nutrition and wellness services to help support employment for individuals with psychiatric disabilities. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Coordinated Beahvioral Care (CBC) Healtfirst, EmblemHealth, BlueCross BlueShield, Affinity, Wellcare, United Healthcare, Metroplus, VNS    
Hamaspik of Kings County Tzvi Wertheimer (718) 408–5106 hwertheimer@hamaspikkings.org www.hamaspikKings.org Kings, New York, Bronx OPWDD, Harp, Children Waiver, NHTD, TBI, HH Care Management Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency        
Harmony Cafe Rosemarie Mccarthy (631) 372–0227 info@harmonycafeli.org   Suffolk Cty We are not aware who receives medicaid–our service we provide doesn´t require having that information at this time. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Harvest House of South Buffalo Carol Murphy (716) 855–0654 ext. 229 cmurphy@harvesthousebuffalo.org www.harvesthousebuffalo.org Erie and Niagara Counties Harvest House works to break down the barriers keeping people in poverty by providing integrated and inclusive support services to underserved and marginalized communities. We offer access to health care and education as well as linkage to services for the working poor, the unemployed, the marginalized and communities at risk. Most come from 3 of Buffalo´s poorest neighborhoods where 55% of residents are African American; 22% are Latino. 40% live at or below the poverty level; 1–in–8 is unemployed; 20% lack a High School diploma. We partner with Kaleida Health´s Youth Link Program/NYS Department of Health/AIDS Institute PrEP Initiative, Family Justice Center, Buffalo Public Schools Adult Education, Erie 2 CC BOCES, UB´s Schools of Medicine, Dentistry, and Pharmacy and more than 90 volunteer medical and dental providers. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks Harvest House is part of the Upstate New York CBO Consortium Fidelis Health Blue Cross Blue Shield Wellcare
HCA Christine Breslin 6077987117x311 c.breslin@hcaserves.com   Broome, Tioga, Chenango social work Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency        
Health Literacy For All Inc Karen Laing (518) 881–6405 info@healthliteracyforall.org healthliteracyforall.org Albany Schenectady Rensselaer Columbia Green Montgomery Saratoga Washington We provide health literacy training to patients and their providers. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Fidelis CDPHP MVP
Health People Chris Norwood 718–585–8585 chrisnorwood@healthpeople.org www.healthpeople.org Bronx We use a Community Asset Model, whereby training community members to facilitate programs, we have staff that fully understands the SDH and gain the confidence of people to address their real needs. The core of our model is evidence–based preventive and self–care education, which not only improves health outcomes but empowers people to want to address their SDH. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   HealthFirst, MetroPlus, Amida Care    
Healthy Capital District Initiative Kevin Jobin–Davis (518) 486–8400 kjobin–davis@hcdiny.org www.hcdiny.org Albany, Schenectady, Rensselaer HCDI provides navigation services to help people of all ages and income apply for health insurance through the New York State of Health. All customers are offered education about how to use their coverage, assistance making appointments with primary care, and help accessing social supports addressing social determinants of health. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks Healthy Alliance IPA CDPHP MVP  
Healthy Community Alliance Ann Battaglia 716–532–1010 abattaglia@hcanetwork.org http://www.communityalliance.org/ Cattaraugus, Chautauqua, Wyoming, Erie Patient Navigation to Primary Care, Evidence–based Chronic Disease Self Management programs, Community Health Worker Coaching, SNAP Enrollment, NY State of Health Insurance Enrollment In Person Assistance, Rural Older Adult Social Connectivity Programs, rural Food Pantry Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks Western New York Integrated Care Hub; Value Network, IPA (BHCC) affiliate CBO member Fidelis YourCare HealthNow
HEAT Program/SUNY Downstate Medical Center Blondell Jackson 718–613–8408 blondell.jackson@downstate.edu www.heatprogram.org Kings County and all surrounding counties of New York City Medical services for HIV+ and high–risk youth; transgender care for youth Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency        
Heights and Hills, Inc. Judy Willig (718) 596–8789 jwillig@heightsandhills.org www.heightsandhills.org Kings Caregiver support services (information, referral, counseling, training and support groups) for individuals providing unpaid care for elderly loved ones, Park Slope Center for Successful Aging – a community center for older adults that provides health and wellness activities and congregate meals Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Hemophilia Association of NY, Inc. Linda Mugford 212–682–5510 lindamugford@Hemophiliany.com www.hemophiliany.com The 5 NY City counties, Nassau, Suffolk, Westchester, Rockland, Sullivan, Ulster, Putnam, Orange, Dutchess We provide direct assistance (financial support for non–medical and non–covered medical expenses deemed necessary) scholarships, research support for new therapies, better therapies and possible cures for bleeding disorders. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Emblem Health, HealthFirst, Healthplus, Affinity    
Henry Street Settlement Kristin Hertel 212–233–5032 x 4253 khertel@henrystreet.org www.henrystreet.org New York County, Brooklyn, Queens Case management ( snap enrollment, housing assiatnce/ PA), legal an dfinacial services, youth services, childcare, Afterschool,employment services, healthcrae enrollment Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency CBC Heakth First, Metroplus, Fidelis, BCBS, Beacon    
Heritage Christian Services, Inc. Jennison Bielemeier 585–340–2000 jbielemeier@heritagechristianservices.org   Cattaraugus, Erie, Genesee, Livingston, Monroe, Niagara, Ontario, Orleans, Seneca, Steuben, Wayne, Wyoming, Yates Heritage Christian Services provides support to individuals with developmental disabilities which includes, but is not limited to, residential, day, respite, employment, community hab, FI, broker, care management within children´s health homes, CDPAP, HCBS children´s provider. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency        
Herkimer County HealthNet Elyse Enea 315–867–1552 eenea@herkimercounty.org www.healthnetinc.org Herkimer & Oneida Counties DSM, CDSM, CPSM, NDPP workshops Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks CBO Consortium of Upstate NY Excellus    
Hillside Children´s Center Maria Cristalli 585–256–7600 mcristal@hillside.com www.hillside.com Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Tioga, Tompkins, Erie, Genesee, Livingston, Niagara, Orleans, Wyoming,Allegany, Cattaraugus, Chautauqua, Chemung, Schuyler, Steuben, Monroe, Ontario, Seneca, Wayne, Yates Hillside serves children/youth ages 0–26 and their families. Our services include clinical and non–clinical. Among the non–clinical, Hillside offers Health Home services, which provvide linkages to a variety of SDH services, including access to health care, Access to primary care, connection to natural resources, linkage to welfare, employment, housing, etc. Additionally, through our Family Resource Center, Hillside provides early education and home visiting services to support parents in being their child´s first teacher and developing sound parenting skills. Hillside offers skill building to advance social development and connection, as well as school–based services that support youth to obtain a high school diploma and readiness for the future (college, skills training, certification, work). Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Your Health Partners of the Finger Lakes, LLC (formerly Hillside–Catholic Charities BHCC) Fidelis Excellus  
Hispanic AIDS Forum Daniel Castellanos 718–429–5309 dcastellanos@hafnyc.org http://hafnyc.org/ New York City Our main target populations are Hispanics and LGBTQ persons. We provide housing assistance, linkage to care, HIV/HCV testing and screening, linkage and navigation services to health and social services, and community education. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Hi–Tech Charities Dr. Francis Onukwue (314) 922–7139 fonukwue12@aol.com www.htc.ngo Bronx, Manhattan, Queens, Brooklyn, Staten Island, Westchester. Hi–Tech Charities (HTC) is a 501(c)(3), nonprofit community development corporation, with operations in St. Louis Missouri and New York City, New York. The organization provides healthcare, employment training, facilities and housing development, and various economic development and social services that empower individuals, families, businesses and communities. HTC has served over 20,000 individuals and families and over 400 hundred women and minority small businesses in its 18 years of existence. The organization´s New York office is presently located at 60 Saratoga Avenue, Pleasantville, Westchester, NY 10570. HTC New York is a New York State Department of Health approved License Home Care Services Agency (LHCSA–2307–L001), presently serving clients in Bronx, Brooklyn, Queens, Manhattan, Staten Island, and Westchester Counties in New York State. Home healthcare services provided include: Nursing, Home Health Aide, Personal Care, Physical Therapy, Occupational Therapy, Respiratory Therapy, Speech–Language Pathology, Medical Social Services, Nutrition, Homemaker, Housekeeper, Medical Supplies, Equipment and Appliances. Visit us at: www.htc.ngo Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   Archcare Integra  
Hope 7 Samantha Adkisson (518) 272–8029 hope7.samantha@gmail.com www.hopeseven.com Rensselaer primarily, some Albany with our youth programs Food Pantry Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Hospice & Palliative Care, Inc. Shannon Cayea (315) 735–6487 scayea@hospicecareinc.org www.hospicecareinc.org Herkimer, Oneida, & Madison Hospice & AIM Palliaivte Care for any individuals residing in the counties we service Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   Fidellis, MVP    
Housing Assistance Program of Essex County, Inc. Bruce Misarski 518–873–6888 bruce@hapec.org www.hapec.org Essex, Clinton, Hamilton HAPEC provides a full range of housing services that include: rental assistance; housing repair asssistance; housing counseling for eviction, foreclosure, and financial capability; emergency accessibilty assistance Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Housing Works Pat Troy (845) 674–3354 P.TROY@HOUSINGWORKS.ORG www.housingworks.org Bronx, Kings, Queens, Manhattan Housing Works includes the following programs: Four (4) Article 28 clinics, two (2) OASAS programs, two (2) Article 31 programs, two (2) Adult Day Health Care Programs, Health Home, Harm Reduction programs including Syringe exchange, Retention and Adherence program, Job Training and Programs transitioning clients from jails to jobs. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency IDUHA IPA Amida Care, Metropus, HealthFirst, Fidelis    
Hudson Valley Community Services Saqib Altaf 914–785–8210 saltaf@hudsonvalleycs.org www.hudsonvalleycs.org Westchester, Rockland, Putnam, Orange, Sullivan, Ulster, and Dutchess Housing financial assistance an dsupport, nutrition education and food programs, transportation Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers Coordinated Behavioral Health Servces IPA (CBHS) MVP Fidelis Affinity
Human Development Services of Westchester Kathy Pandekakes 845–590–7645 kipandekakes@hdsw.org www,hdsw.org Westchester Housing/Residential services, food pantry for clients of our Clubhouse program, Supported Education, Supported Employment, Care Management supports to link to access to health to health care, social engagement, affordable housing, health literacy,etc. Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers Coordinated Behavioral Health Services, IPA MVP    
Human Services Coalition John Mazzello (607) 273–8686 jmazzello@hsctc.org hsctc.org Tompkins County and Cortland County (a subset of HSC services) 211 Information and Referral, Community Health Advocates, Health Insurance Navigation, Community Health Outreach Program, Continuum of Care (lead agency for a network of public & private nonprofit partners addressing homelessness), Coordinated Assessment System (for people who are homeless or at risk of being homeless). Also supports the nonprofit community through training workshops, planning & coordination, collection of data, and administers the rural health network, population health improvement program, and staffs the Health Planning Council. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Fidelis, Molina    
ICAN Matthew Buono (315) 731–2641 mbuono@ican.family ican.family Oneida, Onondaga, Madison, Herkimer, Otsego, Adult Health Home, Adult HCBS, Adult TBI Program, Childrens ACT, Children – CFTSS & HCBS, VBP with adult diabetic population, prenatal and pregnant women in Oneida County, Healthy Families program, Rapid Re–Housing Programs through Oneida County CoC (HUD), Juvenile Justice and School Based Programming Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency ICAN Administers a Behavioral Health IPA – ICAN IPA Fidelis    
In Our Own Voices, Inc. Tandra LaGrone (1518) 432–4188 tlagrone@inourownvoices.org www.inourownvoices.org Albany, Schenectady, Saratoga, Greene, Columbia, Rensslaer, Montgomery LGBTQ focus: Mental Health Services, Transportation, Housing Referrals, Food, Testing and screening HIV, HepC, Atni–Violence Services Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks AFBH CDPHP    
Institute for Advanced Medicine, Mount Sinai Health System Shruti Ramachandran 212–604–1737 Shruti.Ramachandran@mountsinai.org https://www.mountsinai.org/patient–care/iam New York County, Bronx County, Kings County, Queens County, and Richmond County Social Work/Case Management assessment and referrals for all new patients for immediate needs such as linkage to insurance and benefits, affordable housing, job placement/training, access to food pantries and other agencies providing access to healthy foods, GED classes, re–entry support services for justice involved individuals, linkage to internal language translation services, referrals to Crime Victims Treatment Center and our internal Sexual Assault and Violence Intervention program, linkage to on site/co–located nutritionist for nutrition therapy and linkages to local food pantries; Metrocards are provided for those patients who have trouble traveling to and from for a medical visit; Social support groups for LGBT populations, formerly incarcerated/justice involved patients, our aging/50+ population, and our transgender patients seeking gender affirming surgery; Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Mount Sinai IPA https://ms–ipa.org/ Amida Care Inc. SNP and Medicaid Managed; VNS Choic SNP and Medicaid HMO; Healthfirst Medicaid; Healthfirst Medicare; Aetna, Healthfirst HARP; UHC Oxford Commercial, Cigna, Anthem commerical PPO; UHC Commercial; ADAP Medicaid; Empire BC/BS Commercial; Metroplus Medicaid; Fidelis Medicaid;    
Institute for Family Health –––– ––––– –––––––– ––––– Dutchess County Connection to community resources, education, support Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   MVP and Fidelis Medicaid    
Interfaith Partnership for the Homeless Kristen Giroux (518) 434–8021 kristeng@interfaithpartnership.com   Albany, Rensselaer, Montgomery, Schenectady, Saratoga IPH provides a continuum of services to homeless and low–income individuals and families, including 3 emergency shelters, a Medical Respite shelter, a drop–in/community center (showers, lockers, laundry, clothing, a hot meal, case management), permanent supportive housing, health and wellness services, and the Albany Ambassadors employement initiative. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks Healthy Alliance IPA CDPHP Fidelis Wellcare
International Institute of Buffalo May Shogan (1716) 883–1900 mshogan@iibuff,org www.iibuffalo.org Erie and Niagara County We provide advocacy, support, language access, health literacy, linkage and referrals to services for our refugee and immigrant population support, and Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks Healthy Community Alliance      
Ithaca Neighborhood Housing Services, Inc. (INHS) Johanna Anderson (607) 277–4500 janderson@ithacanhs.org   Cayuga, Cortland, Chemung, Seneca, Schuyler, Tompkins, Tioga INHS provides affordable rental, home ownership, and home improvement programs for low– and moderate–income people. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks CHDO, CDFI, NeighborWorks, Neighborhood Preservation Company, Rural Preservation Company      
JASA Alan Cohen (212) 273–5346 acohen@jasa.org   New York County (Manhattan), Kings County (Brooklyn), Bronx County (The Bronx), Queens County (Queens), and Nassau County Adult Protective Services: Supervision of daily activities, crisis intervention, and financial management; Caregivers Support: Groups, respite services, and referrals; Care Transitions: Recently discharged hospital patients work with specialists to ease the transition from hospital to home;Case Management: Counseling, information, and connection to community resources; Chronic Disease Management: Evidence–based programs and peer Community Health Navigators assist with disease management strategies; Community Guardian Program: Legal responsibility for older adults judged incapacitated by the courts; Elder Abuse Prevention and Intervention: Attorneys and social workers assist victims of abuse; Home–Delivered Meals: Nutritious meals delivered to homebound older adults; Home Care: Home health and personal care assistance (LHCSA); Housing: Affordable, safe housing with service coordination for tenants; Legal Services: Legal assistance to prevent evictions and more; Long Island Center for Dignity and Support: Support for individuals and families coping with advanced illness; Mental Health Services: New York State–licensed outpatient mental health clinic in the Bronx and other supportive programs that welcome older adults with mental illnesses; Naturally Occurring Retirement Communities (NORCs): Health, education, and recreation, for older adults living in buildings where many residents are 60+; Senior Centers: Activities, friendships, trips, special events, and meals Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency        
Jawonio, Inc Jane F. Mullin (845) 708–2003 jane.mullin@jawonio.org   Orange, Rockland, Westchester HH Care Management, PROS, CDPA, Day Habilitation, PT, OT & Speech services, Serve individuals with I/DD, BH and MH needs, Medically fragile adults and children Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Behavioral Health Care Collaborative (BHCC) Fidelis MVP Affinity
JCC of Marine Park Michael Rinkoff (718) 407–1832 mendy@jccmp.org www,jccmp.org Kings (Brooklyn), Queens and New York Our services are provided to all within our catchment area, as described above. The services provided involve programs that deal with cases of need primarily food security, but more importantly finding programs of retraining at even the most basic levels in order to increase opportunity and advancement Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
JCCA Carletta Green (347) 362–8180 greenca@jccany.org www.jccany.org NYC,Kings, Queens, Richmond, Bronx, Westchester JCCA addresses medical, mental, behavioral and social health needs with over 30 programs. We work with a wide spectrum of clients (ages 0–21) with a variety of needs. We have partnerships OCFS, ACS, OMH, DOH and OPWDD. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency CBC HealthFirst    
Jewish Family Service of Buffalo and Erie County Molly S. Carr 716–883–1914 ext 307 mcarr@jfsbuffalo.org www.jfsbuffalo.org Erie and Niagara County Health Home Service for Adults and Children, Mental and Behavioral Health Clinic, Refugee Resettlement Care Coordination, Survivors of Torture Care Coordination, Occupational Support Services, Parenting Classes Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   Independent Health BlueCross BlueShield United Health Care
Job Path, Inc. Fredda Rosen (212) 944–0564 frosen@jobpathnyc.org www.jobpathnyc.org New York, Bronx, Kings, Queens Job Path helps people with autism, intellectual and other developmental disabilities find jobs, live in their own homes and participate in community life. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   n/a    
Ken–Ton Meals on Wheels Dan Wiles 716–874–3595 dan@ktmeals.org kentonmealsonwheels.org Erie Home Delivered Meals, Handyman Services, Congregate Dining Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Konbit Neg Lakay, Inc Yola Moiso (845) 425–4623 yolamoiso@konbitneglakay.com www.konbitneglakay.com Rockland, Orange Transportation to local QHC; Diabetes Self–Management Education; ESL classes; Transporation to Behavioral Outpatient treatment; Job Fairs Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks Lower Hundson CBO      
L.I. Against Domestic Violence Colleen Merlo (631) 666–7181 c.merlo@liadv.org   Suffolk, Nassau domestic violence counseling, advocacy, shelter and vocational training Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Lake Plains Community Care Network Charlotte Crawford 585–345–6110 ccrawford@lakeplains.org http://www.lakeplains.org/ Orleans and Genesee Assistance with the Market Place for enrollement in a Health Care Plan Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Fidelis Care MVP Health Plan BCBS – Health Now of NY Inc.
Lantern Community Services Carol Lemus 212–398–3073, ext 185 clemus@lanterncommunity.org www.lanterncommunity.org Manhattan, Bronx, Brooklyn, Queens supportive housing for chronically homeless adults and youth aging out of foster care Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Unknown    
LEAF Council on Alcoholism and Addiction Julie Dostal 607–432–0090, x. 101 julie@leafinc.org www.leafinc.org Otsego County LEAF provides universal prevention services for Otsego County and participates in public health advocacy at the state and national level. LEAF has 3 main focus areas: 1) Providing prevention education and early intervention at the 12 school districts in Otsego County. 2) Providing population based, community level prevention that reduces access and availability of harmful intoxicants, and reduces community level norms associated with increased use. 3) Court mandated education services for impaired drivers and underage offenders. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   We serve a universal population; with and without health insurance, public or private.    
Learning Disabilities Association of CNY dba LAUNCH Paulette Purdy (315) 432–0665 ppurdy@launchcny.org www.launchcny.org Onondaga We support individuals with learning challenges in school and work by providing assistance in remediation of their disability in functional living skills. Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers Inclusive Alliance      
Learning Disabilities of Western NY Marc Hennig (716) 874–7200 mhennig@ldaofwny.org ldaofwny.org Erie, Niagara,Chautauqua Vocational Employment Services help adults get and keep a job. , Starlight Studio and Art Gallery, a vibrant art studio located in downtown Buffalo, provides an open–art studio environment with individualized guidance as needed for the cultivation of artistic expression with people who have disabilities.ndependent Living In the home or for the home, we provide assistance with services needed to maintain independence in your own home in a community of your choosing. ​ Supports and Services Include: • Finding and Obtaining Housing • Money Management / Budgeting • Diet / Cooking • Shopping • Basic First Aid • Medical and Related Appointment Support • Parenting Skills • Safety • Housekeeping / Laundry • Recreation / Leisure Activities • Community Involvement • Transportation Training • Self Direction • Self Advocacye Educational Advocacy Department assists parents /families through the special education process, as this process can be very confusing and frustrating. Our advocates are trained in the educational law and work with the family to help the student receive what he/she is entitled to under the law. Post–Secondary education is a key to improved transitions and greater success for young adults. Attending and graduating from a post–secondary program can be critically essential to future success. On average, a person with a post–secondary degree will earn substantially more than one with only a high school diploma. Post–secondary education for students with learning and/or developmental disabilities can support life success! Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency        
Legal Services of Central New York Jim Williams 315–703–6533 jwilliams@lscny.org www.lscny.org Broome, Cayuga, Chenango, Cortland, Delaware, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Otsego, Oswego We provide free civil legal services to people living at or below 200% of federal poverty guidelines in the areas affecting the essentials of life including housing, public benefits, employment rights, access to healthcare, consumer matters, immigrant rights, education rights, mental health and homelessness, racial justice, civil reights of juveniles and others in jails and prisions. We also have two programs that provide civil legal services to individuals with HIV and/or cancer. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
legal services of the hudson valley mary grace ferone 9149491305x151 mferone@lshv.org www.lshv.org westchester, putnam, rockland ,dutchess, orange ulster, sullivan civil legal services including public benefits, medicaid, housing, social security , family, discrimination Unsure        
Lexington Center for Mental Health Services, Inc. Adele Agin (718) 350–3110 aagin@lexnyc.org https://mentalhealth.lexnyc.org/ Queens, Kings, Bronx, New York, Richmond, Long Island, Westchester The Lexington Center for Mental Health Services, NYC, NYS certified outpatient clinic, provides mental health and social services to deaf and hard–of–hearing people in a linguistically and culturally accessible manner recognizing the importance of utilizing every means of communication. Therapists/clinicians serve individuals from children to adults from crisis intervention to ongoing treatment. Individual, family, group and couple counseling, psychotherapy and case management services are provided. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Coordinated Behavioral Care IPA, Inc. HealthFirst Metroplus Fidelis
Liberty Resources, Inc. David Harris 315–425–1004 dharris@liberty–resources.org http://www.liberty–resources.org/ Oswego,Onondaga,Madison,Cortland,Chenango,Cayuga,Monroe,Erie Housing,homelessness, employment, social and family Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   Fidelis Molina  
Lifelong Lucia Sacco 607–273–1511 lsacco@tclifelong.org www.tclifelong.org Tompkins Free tax counseling for seniors and individuals with low income; free, nonbiased Medicare counseling; we provide a wide variety of activities geared toward older adults in Tompkins County Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks CBO consortium of Upstate NY      
LifePath formerly Senior Services of Albany Monika Boeckmann 518–465–3322 mboeckmann@seniorservicesofalbany.com www.seniorservicesofalbany any Albany We provide nutrition support an dedcuation via the Meals on Wheels program, and our 10 community dining sites. We provide transportation and adult day services for senior who can not safely remain alone at home. We serve adults over 60. ites Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks Alliance for Better Health IPA Fidelis    
Life´s WORC, Inc. Craig Meyer 516–741–9000 cmeyer@lifesworc.org www.lifesworc.org Manhattan, Queens, Nassau and Suffolk Residential and Community Services Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   ACA    
Lifespire Jim Normandy 212 741 0100 JNormandy@Lifespire.org Lifespire.org Manhattan, Bronx, Queens, Kings & Staten Island Clinic = Psychotherapy, Speech, OT, PT for IDD people Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency        
Lifetime Assistance Inc Kevin Koch 585–426–4120 Kevin.Koch@lifetimeassistance.org https://www.lifetimeassistance.org Monroe, Genesee service for developmental disabilities Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency        
Literacy New York Buffalo Niagara Tara Schafer 716–876–8991 tara.schafer@literacybuffalo.org Literacybuffalo.org Erie & Niagara Literacy Education for adults Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Health Now, Independent Health    
Literacy of Northern NY M. Cecilia Brock 315–782–4270 literacyofnny@gmail.com www.literacynny.org Jefferson, Lewis We provide literacy tutoring so people can read information they receive from the doctor or pharmacist. We also teach English as a second language so people can communicate and understand their medical professionals. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks CBO Consortium of Upstate NY United Healthcare    
LiteracyCNY Marsha L. Tait 315–471–1300 X171 mtait@LiteracyCNY.org www.LiteracyCNY.org Onondaga LiteracyCNY provides basic literacy and English language instruction to adults who read, write or speak English below the sixth grade level. Instruction is offered in small group classes of 15–18 students taught by credentialed teachers and in one–to–one pairs with trained volunteer tutors. LiteracyCNY enrolls more than 350 adult students per year. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Living Independently is For Everyone at RCIL Donna Gillette (315) 866–7245 dgillette@rcil.com www.rcil.com Herkimer County/ and 26 counties covered by our Medicaid Consumer–Directed Personal Assistance Program (CDPAP) providing fiscal intermediary services to individuals qualified for long–term care services in the home. Medicaid CDPAP services through RCIL are offered in 26 counties. For a full listing of counties covered by our CDPAP program, see addendum. Providing consumer–directed advocacy and assistance to individuals with disabilities to access healthcare, education, employment, civic involvement, benefits, programs and services to live as independently as possible. RCIL also provides services to care givers of seniors with disabilities including a social adult day program for seniors with developmental and cognitive impairments including dementia. Support for care–givers of individuals with disabilities, their healthcare providers, including peer recovery support services and those with co–occurring diagnoses including mental illness. All of our programs and services are aimed at addressing social determinants of health including housing, benefits, food security, IPE and 504 advocacy in schools, employment assistance, and nursing home transition and diversion advocacy. We house the NY Connects program that works together with the HC Office for Aging to connect residents with information, assistance and referral to long–term care.We partner with the HC Dept. of Social Services and have staff located there assisting DSS staff with individuals receiving benefits who are work exempt or work limited. Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers Leatherstocking Collaborative Health Partnership (LCHP) PPS/DSRIP; Herkimer County Steering HUB Fidelis, Excellus, Senior Network Health, United Healthcare    
Long Island Alzheimer´s Foundation Melissa Katz, LMSW 516–767–6856 mkatz@liaf.org   Nassau County Alzheimer´s disease and dementia specific– social adult day program contacted with MLTC´s, free caregiver support groups and trainings, In–Home Respite Services funded by Office of the Aging Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Long Island Cares Jessica Rosati (631) 582–3663 jrosati@licares.org www.licares.org Nassau and Suffolk Food Bank Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Long Island Consultation Center, Inc. Nancy Tartakoff (718) 896–3400 nancytartakoff@aol.com liccnewyorkcity.com All boroughs of New York City and Long Island: New York, Queens, Brooklyn, Staten Island, Bronx, Nassau, Suffolk Outpatient MH and SUD treatment, psychiatric med mgmt, MATS Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Behavioral Health NYC IPA Health First Empire BCBS Health Plus Metro Plus
LSA Family Health Service, Inc. Ray Lopez (917) 445–6621 rlopez@lsafhs.org https://littlesistersfamily.org/ New York – Manhattan Skilled nursing from our Certified Home Health Agency. Community Health Workers provide in–home asthma services. Community Liaison Wokers provide SDH assessment to patients recently out of the emergency department of our partners, identifies barriers, and connects them to services in their community. Parenting & Child Development services to immigrant families in particular. The children have Medicaid Managed Care and the parents are uninsured. Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers   Affinity, Health First, FidelisCare, MetroPlus    
Madison County Rural Health Council, Inc. Bonnie Slocum 315–447–7625 slocum.bonnie@mcruralhealthcouncil.org www.mcruralhealthcouncil.org Madison National Diabetes Prevention Program, Chronic Disease Self Management, Diabetes Self Management and Chronic Pain Self Management programs, Mobility Management, Health Literacy awareness Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks CBO Consortium      
Make the Road New York Becca Telzak 347–512–9073 rebecca.telzak@maketheroadny.org www.maketheroadny.org Queens, Kings, Staten Island, Suffolk, Nassau, Westchester Health (insurance enrollment, SNAP enrollment, pantries, healthcare navigation, CHW training and asthma home visiting services), Legal (immigration, housing, employment), adult education (ESOL and citizenship classes), community organizing/weekly meetings Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Mary Rose Clinic Amanda Larson 315–280–0855 amanda@gormanfoundation.org www.maryroseclinic.org Madison, Oneida, Onondaga, etc. No limits We provide primary care to uninsured and underinsured people. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Matthew House, Inc Angela Ryan (315) 252–2052 info@matthewhouse.org Matthew House, Inc Cayuga, Onondaga, Seneca and surrounding areas End of Life Care Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Meals on Wheels of Syracuse Mason Kaufman, Executive Director 315–478–5948 ext:204 mkaufman@meals.org www.meals.org Onondaga County (City of Syracuse, Nedrow, Onondaga Nation, Skaneateles,Jordan, Elbridge) Two well–balanced home delivered meals to homebound adults; includes daily safety check by delivery volunteers. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Nascentia Health Options, Fidelis Care, PACE CNY, iCircle Care    
Mental Health America of Dutchess County Andrew O´Grady (845) 473–2500 aogrady@mhadutchess.org mhadutchess.org Dutchess Mental Health America Dutchess County is a not–for–profit organization dedicated to promoting mental wellness through comprehensive care management, education, programs, advocacy, and community supports. We provide compassionate creative care for all. MHADC envisions a community in which every individual is treated with dignity and respect and where comprehensive mental health services of the highest quality are available and accessible to all. Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers   Fidelis Beacon Health Options Wellcare
Mental Health Association in Orange County, Inc. Nadia Allen (845) 342–2400 ext. 1326 nadia@mhaorangeny.com http://www.mhaorangeny.com/ Orange County Care Coordination, Housing Support, Vocational Support, Peer Mentor, Social Club, 24 hour Crisis Call Center Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers   I am not sure    
Mental Health Association of Franklin County Inc. (d/b/a) Community Connections of Franklin County Lee Rivers 518–521–3507 lrivers@communityconnectionsfcny.org communityconnectionsfcny.org Franklin We have collaborative partnerships with DSS, Probation, JCEO, Franklin County Community Housing Council, Landlords, Churches, Sherriffs Department, Probations, Family Treatment Court, Food Pantries, St. Joes Outpatients, Citizen Advocates, UVN Alice Hyde Medical Center, Saranac Lake School System, Malone School System, Chateaugay School System which allows us to help address all Social Determinants of Health either at our facility or through a referral process. We offer advocacy(connection), benefit advisement, mutual support, warm–line, work experience program, male homeless shelter, education on life and social skills, groups, co–chair agency for Franklin County Suicide Prevention Coalition,Recipient Services Funds to assist with environmental conditions, job readiness training, Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers Wellness Collaborative IPA of NY Fidelis Optum  
Mental Health Association of Rockland Sonia Wagner 845–267–2172, x323 wagners@mharockland.org   Rockland care management for adults and children, ACT team, residential services, vocational services Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Coordinated Behavioral Health Services (CBHS) Fidelis    
Met Council Julia Kessler–Hollar 212–453–9598 jhollar@metcouncil.org www.metcouncil.org Manhattan, Bronx, Brooklyn, Queens, Staten Island For more than four decades, Met Council has helped seniors, adults and families living in poverty and near–poverty. Met Council provides immediate assistance to New Yorkers in crisis and creates pathways to self sufficiency through the following programs: America´s Largest Kosher Food Pantry System, Emergency Social Services, Family Violence Services, Free Home Repairs, Benefits Enrollment & Outreach, Senior Services, Holocaust Survivor Program and Affordable Housing. Our grassroots network of sixteen Jewish Community Councils help people in their neighborhoods—right where they live! Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Unknown    
Metropolitan Center for Mental Health Robert Basile 2128751300x508 rbasile@metropolitancenter.com www.metropolitancenter.com New York, Bronx Behavioral Health, Integration with Primary Care, Linkages to Health Home/Care Management, Linkages to Medicaid benefits support, Linkages to Foodbank, Supportive Housing, HRA STARS program Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Behavioral Health NYC, IPA, LLC (BHNYC) HealthFirst    
MHA of Westchester Charlotte Ostman 914–265–7509 OstmanC@mhawestchester.org mhawestchester.org Westchester, Rockland, and Putnam Apartment Treatment Program, Supported housing beds, Employment services, Rep Payee services, Care Management for adults and children Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Coordinated Behavioral Health Services MVP    
Mixteca Organization, Inc. Lorena Kourousias (718) 965–4765 lkourosias@mixteca.org www.mixteca.org City wide For nearly two decades, Mixteca´s culturally–competent staff, community–based engagement strategies and welcoming community center have helped to connect marginalized community members to critical health information, resources, health and emotional health services and support. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
MOMMAS House Patricia Shea (516) 781–8637 director@mommashouse.org   Nassau and Suffolk MOMMAS House is a mother–child residential program for young mothers, pregnant and/or parenting mothers Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Health First Affinity Fidelis
Mount Sinai Adolescent Health Center John Steever (212) 731–7517 John.steever@mountsinai.org https://www.mountsinai.org/locations/adolescent–health–center New York City Provide comprehensive medical and mental health care to youth ages 12–24 in New York City. Emphasis on sexual and reproductive health care. Unsure        
Municipal Housing Authority of the City of Utica Robert R. Calli 315–735–5246 bcalli@aol.com www.uticamha.org Primary County– Oneida but have authority to operate throughout NYS Affordable housing provider/ Developer of affordable and market rate housing/ service coordinator for residents in need/ Targeted Populations– low/moderate income/indigent/elderly/disabled/at–risk/ Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   N.Y. Quality Healthcare corporation Excellus Health Plan , Inc. MVP Health Plan, Inc.
NADAP Joseph Sarno (516) 620–1363 jsarno@nadap.org   Nassau and Suffolk Vocational services for individuals living with HIV/AIDS Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
NAMI Champlain Valley Amanda Bulris–Allen 518–419–9182 amanda@nami–cv.org nami–cv.org Clinton Peer Advocacy and Outreach services to those struggling with their mental health and their family Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Fidelis, Excellus    
Nassau/Suffolk Law Services Victoria Osk (631)232–2400x3329 vosk@nsls.legal www.nslawservices.org Nassau and Suffolk Legal services & permanency planning Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Various    
Nassau–Suffolk Hospital Council Wendy Darwell 631–963–4152 wdarwell@nshc.org www.nshc.org Nassau, Suffolk 1. Medicaid and Medicare insurance enrollment assistance for aged, blind and disabled populations. 2. Coordinate population health improvement activities among more than 100 providers, local governments and CBOs. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Fidelis UnitedHealthcare  
New Hope Transformation House Ministries, Inc./Grace House Carolyn M. White 315–268–9109 whitegracehouse@outlook.com newhopetransformation.org St. Lawrence County supportive living for women in early recovery from SUD Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   most of our residents appear to be enrolled in Fidelis    
New Horizons Resources, Inc. Nancy Slauson, CFO 845–473–3000 nslauson@   Ulster and Dutchess Residential and Day programs Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency        
New York Council On Adoptable Children Cyndi Morales (212) 475–0222 cmorales@coac.org www.coac.org Manhattan, Bronx, Brooklyn, Queens, and Staten Island supportive counseling, legal, and care coordination Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   MCAID    
NEw York Foundation for Senior Citizens Jaimeson Champion 212–962–7559 ext 272 jaimesonc.nyfsc@gmail.com nyfsc.org New York, Kings, Queens, Bronx, Richmond Social Services for Senior Citizens Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
North Country Healthy Heart Network Ann Morgan (518) 891–5855 amorgan@heartnetwork.org www.heartnetwork.org Clinton, Essex and Franklin We promote health equity by working with organizations that directly address social determinants of health to gain access to disparate populations that can benefit from increased access to chronic disease prevention services. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Fidelis    
North Country Prenatal/Perinatal Council, Inc. Tina Cobb 315–788–8533 ext 227 tcobb@ncppc.org www.ncppc.org Jefferson, Lewis, and St. Lawrence For 30 years, NCPPC has been providing a variety of services across Jefferson, Lewis and St. Lawrence counties. Services cover the age continuum with all programs address the SDoH. Programs include: home visiting for maternal and infant health and chronic disease, risk reduction, assistance with access to healthcare/insurance through the NY State of Health Marketplace, Community Health Advocate programming which addresses health literacy, billing and access to care issues; prevention programs addressing adolescent pregnancy; CDSMP, health literacy, social isolation, avoidable hospitalizations, and a myriad of other services. NCPPC partners with a vast number of partners, over 100, to address the SDoH. Partners include: hospitals, CBOs, transporation, providers, business, etc. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Excellus Health Plan, Inc MVP Health Plan, Inc.; United Health Care of New York, Inc New York Quality Healthcare, Corpoartion
North Shore Child and Family Guidance Center Andrew Malekoff 516–626–1971 amalekoff@northshorechildguidance.org   Nassau County Outpatient Mental Health for children from birth to 24 and their families Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency AHN/RHS – Advanced Health Network / Recovery Health Solutions      
Northeast Parent & Child Society, Inc. Kelly Busch, Esq. 518–426–2635 kelly.busch@northernrivers.org   Albany, Broome, Chenango, Chemung, Clinton, Columbia, Cortland, Delaware, Dutchess, Essex, Franklin, Fulton, Greene, Hamilton, Herkimer, Jefferson, Montgomery, Oneida, Oswego, Orange, Otsego, Rensselaer, Rockland, Saratoga, Schenectady, Schohaire, Sullivan, St. Lawrence, Tompkins, Tioga, Ulster, Warren, Washington, Westchester, Yates Care management and community–based clinical services, licensed behavioral health, residential and foster care services, educational services Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   CDPHP Fidelis Optum
Northern Manhattan Improvement Corporation Morgan Siegel 212–822–8300 EXT 410 morgansiegel@nmic.org https://www.nmic.org/ New York, Bronx Eviction Prevention, Immigration, Organizing, Adult Education, Domestic Violence, Food Security, Employment Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Northern Manhattan Perinatal Partnership Adrienne Mercer 212 665 2600 ext 302 adrienne.mercer@nmppcares.org   Northern Manhattan Maternal Child Health Home visiting and Early Learn Head Start Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Health First    
Northern Regional Center for Independent Living, Inc Aileen Martin 315–785–8703 aileenm@nrcil.net www.nrcil.net Jefferson, Lewis and St. Lawrence Counties We provide services for any person with any disability of any age. Our specialty is advocacy in life domains such as health care, housing, employment, education. We also provide independent living skills development, peer support, information and referrals and transition supports. Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers   United Healthcare    
Nysarc, Columbia County DBA – Coarc Ken Stall – CEO 518–672–4451 kens@coarc.org www.coarc.org Columbia Services to individuals witih developmental disabilties including housing, employment, and Day Habilitation activites Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Not yet, but will be shortly. IPA not formed yet but discussions are taking place. CDPHP Empire soon to be ´Parnters Health Plan´
OAR of Tompkins County Deborah Dietrich (607) 272–7885 debsterdietrich@gmail.com www.oartompkins.org Tompkins, Schuyler Assist individuals with applications for Medicaid, refer to providers i.e. TC Mental Health, ADC, REACH,. Provide limited housing (5) for formerly incarcerated males. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks CBO Consortium of Upstate NY Excellus Health Plan Fidelis Care  
Office for Aging Broome Co. DeeDee Camp 607–778–2064 dcamp@co.broome.ny.us www.gobroomecounty.com Broome Nutrition education, counseling, application assistance, CDSM, Adult Day care, Home delivered meals Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers   Fidelis    
Olmsted Center for Sight Kelly Dodd (716) 842–2608 kdodd@211wny.org www.olmstedcenter.org Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming comprehensive services for individuals with visual impairments or blindness including early intervention services, adjustment to vision loss, employment, senior vision services, also operated 211WNY comprehensive information & referral service Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency        
Onondaga Council on Alcoholism & Addictions, Inc. d.b.a. Prevention Network Beth E. Hurny 315–471–1359 bhurny@preventionnetworkcny.org www.preventionnetworkcny.org Onondaga, Cortland, Madison, Cayuga, Oswego, Otsego, Delaware, St. Lawrence, Jefferson, Lewis, Oneida, Herkimer, Chenango Prevention Network provides community based prevention services/programs across the lifespan. We use evidence–based strategies to reduce risk factors and increse protective factors. We address multiple social determinants of health by working collaboratively with other community partners. Substance use and mental health issues are often an impactor of SDH. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks Inclusive Alliance      
Open Door Family Medical Center Andrea B Ruggiero (914) 502–1479 aruggiero@odfmc.org opendoormedical.org Westchester, Putnam, Ulster Health Home, Nutrition, Dental, Primary Care, School Based Health Centers, Optometry, Podiatry, Wellness, Educational Groups (DPP), Behavioral Health, SUD Services, etc Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   MVP, Affinity    
Options for Community Living, Inc. Georgia Kuhen 631–361–9020 x 1220 gkuhen@optionscl.org www.optionscl.org Suffolk and Nassau Counties Health Home Care Coordination, housing, case management Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers AHN (Advanced Health Network) Healthfirst, Fidelis, Affinity    
Osborne Treatment Services Christina Mansfield 718–707–2693 cmansfield@osborneny.org osborneny.org Bronx substance abuse treatment for people with criminal justice involvement Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency CBC cbcare.org HealthFirst, Metroplus, Fidelis    
Oswego County Opportunities, Inc. Patrick Waite 315–598–4717 ext. 1016 pwaite@oco.org www.oco.org Oswego County OCO provides a variety of helaht and human services to individuals in Oswego County. This includescrisis intervention, housing, transportation education, case management, health care Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency INclusive Alliance, CNY Care Partners, LifeTime      
Otsego County Office for the Aging Tamie MacDonald 607–547–7571 macdonaldt@otsegocounty.com https://www.otsegocounty.com/departments/office_for_the_aging/index.php Otsego Otsego County Office for the Aging assists residents age 60 and older and their caregivers by providing services and support to help older adults live safely and independently in their home and community. OFA services include non–medical personal care, case management, benefit screening, application assistance, personal emergency response systems, home delivered meals, congregate meal sites, nutrition counseling, legal services, tax preparation, transportation, caregiver respite (in–home, short–term facility or adult day care) and Tai Chi for Arthritis. NY Connects is available to people of any age with a disability, their caregivers and professionals to navigate long term services and supports. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks Mohawk Valley Network Hub (working on formation)      
Outreach Development Corp. Tony Croce (718) 847–9233 anthonycroce@opiny.org www.opiny.org Queens, Kings, Suffolk & Nassau Substance Use Disorder/Behavioral Health Treatment: Training of aspiring behavioral health and substance use disorder professionals. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Recovery Health Solutions www.recoveryhealthsolutions.com Beacon, HealthFirst, Fidelis    
Outreach HealthCare Sara Stern (1718) 855–6666 sstern@outreachhc.org   5 Boros NYC / Orange and Rockland counties NY Care Management/ Advocacy/ Creation of services in HPSA areas Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Brooklyn HUB HealthFirst United HealthCare Fidelis
Parent Network of WNY Susan Barlow (716) 568–6366 srb@parentnetworkwny.org www.parentnetworkwny.org Erie, Niagara, Chautaqua, Cattaraugus; Orleans, Genesee, Wyoming Parents/Families of people with a Disability (all ages) Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   IHA Fidelus Your health
ParentChild+ Andre Eaton 5168837480   Kings, Bronx, Queens, New York, Erie, Monroe, Suffolk, Nassau, Westchester, Rockland, Onondaga ParentChild+ uses education to break the cycle of poverty for low–income families. We engage early in life and help toddlers, their parents, and their family child care providers access a path to possibility through an early childhood home visiting model. . This addreeses the SDS on family engagement, early literacy and education. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Parker Jewish Institute for Health Care and Rehabilitation Loraine Breuer (718) 289–2102 lbreuer@parkerinstitute.org www.parkerinstitute.org Nassau, Suffolk, Queens, Kings, New York, Bronx, Westchester Skilled nursing, home care, hospice Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency        
Parsons Child and Family Center Kelly Busch, Esq. 518–426–2635 kelly.busch@northernrivers.org   Albany, Broome, Chenango, Chemung, Clinton, Columbia, Cortland, Delaware, Dutchess, Essex, Franklin, Fulton, Greene, Hamilton, Herkimer, Jefferson, Montgomery, Oneida, Oswego, Orange, Otsego, Rensselaer, Rockland, Saratoga, Schenectady, Schohaire, Sullivan, St. Lawrence, Tompkins, Tioga, Ulster, Warren, Washington, Westchester, Yates Care management and community–based clinical services, licensed behavioral health, residential and foster care services, educational services Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Healthy Alliance IPA CDPHP Fidelis Optum
Partners in Care Jessica Williams 212–609–5051 jessica.williams@vnsny.org www.vnsny.org New York, Queens, Kings, Bronx, Richmond, Nassau, Suffolk, Westchester • Care management services address clinical, behavioral health, and social determinants needs. Key to this model is engagement of paraprofessional health coaches who conduct health literacy and serve as community navigators. Care Managers conduct SDH risk assessments, stratification and use search engine technology (like Healthify) to link individuals to services to address economic instability, housing instability, food insecurity, family/community support, and health literacy. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   VNSNY CHOICE MLTC    
PATH Center at The Brooklyn Hospital Sheila Anane 718–250–8408 sanane@tbh.org https://www.tbh.org/ Kings, Queens, Bronx, New York, Richmond PATH provides healthcare, case management, mental health, nutrition, and social services to individuals with or at risk for contract HIV. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency        
PathStone Sislyn Vazquez (585) 589–5511 svazquez@pathstone.org https://www.pathstone.org/ Orleans We provide education, advocacy, linkage services to the female incarcerated population inside Albion Correctional Facility. We collaborate with DOCCS, community partners and other Community Base Organizations. Unsure   Medicaid    
Pathways, Inc. Cynthia Gee 607–937–4519 cgee@pathwaysforyou.org www.pathwaysforyou.org Allegany, Broome, Tioga, Tompkins, Steuben, Chemung, Schuyler, Yates, Ontario, Wayne, Seneca, Monroe, Genesee CFTSS, Children´s HCBS, Care Management, Adult HCBS, Day Habilitation, Community Habiltation, Waiver Services for NHTD/TBI/OPWDD, Residential facilities for OMH and OPWDD Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   Fidelis, Excellus, Optum, Molina, MVP, Beacon, Univera, Capital District Physician´s Health Plan    
Peace Valley Haven Inc Daphne Haynes (516) 850–6765 daphhaynes@aol.com peacevalley haven.org USA Peace valler Haven provides emergency services to homeless and the tool to achieve self sufficiency, we also provode tranisionaal housing for homeless senior and casemanagement srvices for homeless women and children in the Hempstead school district. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks HEAL H United Healts and medcade , Medicaid Medicare, Medicaid, Medicaid and Affinity, Medicaid and Health First,    
PEACE, Inc. Carolyn Brown (315) 634–3737 carolyn.brown@peace–caa.org Peace–caa.org Onondaga, Oswego We serve low income individuals from birth to seniors through a variety of programs including Head Start, Big Brothers Big Sisters, Family Resource Centers, Weatherization, Free Tax Prep, Senior Nutrition, Foster Grandparents, Eastwood Community Center and Senior Supports. We promote kindergarten readiness, high school graduation, economic self–sufficiency and seniors aging in place. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Medicaid, Medicare, Molina, United Healthcare    
Peer Coach Academy King McELvy (518) 479–9245 king@peercoachacademy.com www.peercoachacademy.com Albany Troy,Schenectady Peer Advocates,Returning Inmates, High School Seniors, Recovering People Unsure   NA    
Phoenix Houses of NY/LI Ann–Marie Foster 718–222–6608 amfoster@phoenixhouse.org phoenixhouse.org NYC, Long Island, Westchester offer substance abuse services, 820/819 , OMH mental health CR and PROS services Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   Healthplus Beacon United Healthcare
Planned Parenthood of Nassau County Nancy O´Keefe 516.750.2501 nancy.okeefe@ppnc.org ppnc.org Nassau PPNC provides reprodutive health care, including abortion and prenatal care, and limited primary care. Included in this care is screenings for IPV, depression, and alcohol and substance abuse. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   HIP, Affinity, UHC    
Planned Parenthood of New York City Carmina Bernardo 212–274–7277 carmina.bernardo@ppnyc.org www.ppnyc.org Bronx, Kings, New York, Queens, and Richmond We provide social and health services referrals to other organizations if we cannot provide them on site. Referral partnerships include: The Door, Family Justice Center, Safe Horizon, and Community Healthcare Network. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   FidelisCare, Health First, and MetroPlus    
Polonians Organized to Minister to Our Community, Inc. (POMOC) Ewa Kornacka (718) 366–5365 pomoc@verizon.net in progress Queens, Brooklyn, Staten Island, clients from other NY counties health literacy outreach and workshops, individual assistance with all healthcare related issues. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Empire Health Choice HMO Healthfirst United Health Care of NY
Population Health Collaborative John Craik (716) 863–2295 jcraik@phcwny.org https://www.pophealthwny.org/ Erie, Niagara, Chautauqua, Cattaraugus, Orleans, Genesee, Wyoming, Allegany We bring together people and organizations, share resources and measurably improve their skills and connections. As a result, efforts are more aligned, strategic, and meaningful than they would be without our involvement and leadership. As a neutral thought leader and expert, we collectively identify, implement and advance best practices that are proven to improve health and well–being in the 8 counties of WNY. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Blue Cross/Blue Shield of WNY Independent Health Univera
Power of Two Erasma Monticciolo (347) 559–1519 erasmam@powerof2.nyc https://www.powerof2.nyc/ Kings County and New York Our mission at Power of Two is to partner with caregivers to help them develop resilience so that they can better care for their families and promote healthy trajectories for their children and their communities. Through our work, we address the reality that children born into poverty and to families that have themselves experienced trauma are often exposed to prolonged toxic stress and are therefore at higher risk for negative effects on mental health, learning, behavior, and physical health across their lifespan. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Prevention Council of Saratoga County Janine Stuchin (518) 581–1230 execdir@preventioncouncil.org www.preventioncouncil.org Saratoga Healing Springs Recovery Community Center – We are a community center with peer–driven, peer–delivered services, offering hope to those in recovery from addiction and their family members. We have resources, we make referrals and we connect people. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Pride for Youth (Long Island Crisis Center) Devon Zappasodi (631) 940–1964 dzappasodi@longislandcrisiscenter.org http://www.prideforyouth.org/ Queens, Nassau, and Suffolk Counties Pride for Youth provides the following free services to LGBTQ youth up to age 30; social support (EBIs) groups, individual and family counseling sessions, case management services, community level events designed to mobilize the community to access supportive services, in–school workshops in elementary/middle/high schools on homophobia,and transphobia, and PrEP/PEP support program services. For LGBTQ individuals up to age 45, free services include rapid HIV testing, rapid syphilis testing, on–site comprehensive extragential STI testing via medical partner (service is billed), hormone replacement therapy (HRT) for transgender individuals with cannot obtain health insurance due to immigration status, PrEP/PEP screenings/asessments/intakes and enrollment, insurance navigation support, an EBI designed to meet the sexual health needs of Hispanic/Latino LGBTQ individuals (groups held in spanish). All services are available in english and spanish. Pride for Youth also hosts an open food pantry for any clients suffering from food insecurity. This food pantry is in partnership with Island Harvest. Clients accessing any of our services have access to the agency´s free van transportation and/or will be reimbursed the cost of their public transportation usage to and/from services. For the larger community, Long Island Crisis Center, provides 24 hr, 7 days a week, 365 days a year, crisis intervention hotline service for all people. The crisis intervention hotline is available via phone, internet chat, and text with the ability for multilingual translation abilities. Long Island Crisis Center/PFY has partnerships with the following medical health systems: Northwell Health, Damian Family Health Centers, Healthy Transitions LLC, Planned Parenthood, and HRHcare. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Project Hospitality Michelle Gassama 718–448–1544 Mgassama@projecthospitality.org Www.projecthospitality.org Richmond It is the mission of Project Hospitality, Inc. to reach out to community members who are hungry, homeless or otherwise in need in order to work with them to achieve their self–sufficiency — thereby enhancing the quality of life for our community. Project Hospitality seeks to realize its mission both by advocating for those in need and by establishing a comprehensive continuum of care that begins with the provision of food, clothing and shelter and extends to other services which include health care, mental health, alcohol and substance abuse treatment, HIV care, education, vocational training, legal assistance, and transitional and permanent housing. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Coordinated Behavioral Care – CBC Amerigroup, Fidelis, Health First    
Project Renewal, Incorporated Rebecca Stauffer 212–620–0340 443 rebecca.stauffer@projectrenewal.org www.projectrenewal.org Manhattan; Bronx, Kings Since 1967, we have pioneered programs that provide health, homes, and jobs which empower individuals and families to renew their lives. Each year we provide services to 16,000 individuals.We are one of New York City´s largest providers of comprehensive health services to homeless individuals—delivering healthcare to more than 12,000 people a year.We provide award–winning emergency, transitional, and permanent housing to more than 3,900 homeless New Yorkers a year, including veterans and families.We incorporate employment services into every aspect of our programming, connecting clients to services that match their needs. We get adults into competitive jobs quickly and help them stay employed. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   Metro Plus, Health First, Fidelis, Affinity, AmidaCare, Health Plus, WellCare, United Healthcare Community Plan, United Healthcare, Oxford, Emblem Health/GHI    
Public Health Solutions Arielle Burlett (646) 619–6454 aburlett@healthsolutions.org www.healthsolutions.org Kings, Queens, Bronx, New York, Richmond Public Health Solutions´ (PHS) mission is to support vulnerable New York families in achieving optimal health and building pathways to reach their potential. We focus on a wide range of public health issues that affect the ability of New Yorkers to live their healthiest life, including food and nutrition for low–income individuals, families and children at 9 co–located WIC and SNAP centers; access to healthcare for low–income individuals through insurance enrollment navigation and support; maternal and child health through home–visiting programs, including Nurse Family Partnership; and comprehensive reproductive healthcare for women, men and adolescents. We provide services directly to more than 105,000 families each year, and serve more than 240,000 through coordinated networks and public–private partnerships across New York City. We maintain partnerships with approximately 300 community–based organizations and a range of healthcare partners, including New York Presbyterian–Queens, Community Healthcare Network, Health + Hospitals, and managed care including Empire Blue Cross Blue Shield and WellCare. Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers   MetroPlus Healthfirst  
Queens Community House Hannah Lupien 7185925757 x224 hlupien@qchnyc.org www.qchnyc.org Queens Queens Community House (QCH) is a multi–site, multi–service settlement house that serves the diverse neighborhoods of Queens. We are committed to a holistic approach that deals with immediate needs as well as the barriers that may impede personal, family, and community stability. We recognize the interconnected relationship between housing, health, employment, education, self–esteem, and financial wellbeing, and ensure all participants in every program have access to a full range of resources to help them achieve wellness and life–long security. Services include childcare & education, youth employment services, housing, food access, immigration services, and senior services (senior centers, social adult day services, caregiver support, case management, NORC, and home delivered meals). Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
RAIN Inc Jane Bello 718–892–5520 jane.bello@raininc.org www.raininc.org Bronx, Manhattan Housing, benefit etitlements, home delivered meals, case management, evidence based health promotion, congregant meals, transportation, alzheimer´s caregiver support Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Health First    
Rainbow Access Initiative, INC Arlene Lev (518) 463–9152 president@raialbany.com raialbany.com Albany, Schenectady, Rensselaer Rainbow Access Initiative provides low–cost mental health services for LGBTQ community. We also provide transition support for transgender identified individuals. Unsure CBO Consortium of Upstate NY      
REACH CNY, Inc. Elizabeth Crockett 315–424–0009 ext112 execdir@reachcny.org www.reachcny.org Onondaga, Oswego, Cayuga, Madison REACH CNY provides Community Health Worker services for women of childbearing age, including preconception, pregnant, parenting and interconception. Services targeted to women who have health risks and/or are Medicaid eligible. Focus on increasing health equity. Partnerships with NYSDOH and the Onondaga County Health Department and with Oswego County Opportunities. Also, in partnership with SUNY Upstate Cardiology and Adult Health primary care, we provide CHW services to adults with Congestive Hearth Failure and diabetes. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Reach Medical Amy Gecan (858) 228–7773‬ agecan@reachmed.org http://reachprojectinc.org 20 counties in the Southern Tier with locations in Tompkins and Broome We work with all patients who would typically feel they face stigma in health care. Our largest patient population suffers from Opiate Use Disorder, or Hepatitis C, many of our patients have been recently incarcerate Unsure   fidelis    
Recovery Houses Of Rochester,inc. Van L. Smith Jr. (585) 413–0551 van@recoveryhousesofrochester.org www.recoveryhousesofrochester.org Monroe , Wayne ,Erie , Genesee , Ontario, Targeted Population Substance Abuse ,Mental Health , Homeless Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks Behavioral Health Collaborative Excellus Blue Cross Blue Blue Shield  
Regional Aid for Interim Needs, Inc. Jane Arce–Bello 718–892–5520 jane.bello@raininc.org raininc.org Bronx Care Coordination Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Rehabilitation Support Services, Inc. Elizabeth Kadatz (1518) 464–1511 ekadatz@rehab.org   Albany, Schenectady, Rensselaer, Saratoga, Schoharie, Otsego, Delaware, Chenango, Tioga, Westchester, Orange, Sullivan, Ulster, Dutchess Housing, employment for individuals with behavioral health challenges Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Coordinated Behavioral Health Services (CBHS). Also participating in 3 BHCC´s that are awaiting approval of IPAs. Fidelis CDPHP MVP
Resource Center for Accessible Living, Inc. Kathy Hochman 845–331–0541 khochman@rcal.org www.rcal.org Ulster, Dutchess, Columbia, Greene Case Management, employment services, community rehabilitation, respite, benefits advisement, architectural barriers removal, special education advocacy, representative payee services. Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers   MVP Fidelis CDPHP
Resource Center for Independent Living, Inc. Wendy Gagliardo 315–797–4642 wgagliardo@rcil.com www.rcil.com Albany, Bronx, Broome, Cayuga, Chenango, Clinton, Cortland, Delaware, Dutchess, Essex, Franklin, Fulton, Hamilton, Herkimer, Jefferson, Kings, Lewis, Madison, Montgomery, Nassau, New York City, Oneida, Onondaga, Oswego, Otsego, Queens, Rensselaer, Richmond, Saratoga, Schenectady, Schoharie, St. Lawrence, Suffolk, Tompkins, Ulster, Warren, Washington, Wayne Consumer Directed Personal Assistance Program – Fiscal Intermediary for individuals with chronic illness or disability to remain in their homes and avoid institutionalization; Self Direction – Fiscal Intermediary services that allow individuals with developmental disabilities to direct their own services and care; Open Doors (Money Follows the Person) – Resources and supports to individuals transitioning from institutional placement to community–based living; Elderly Services – Respite for caregivers and activities for seniors and their caregivers; Many Hearts Senior Care Center – social model adult day program; Olmstead Housing and Rapid Transition Housing – Transition services and rental support to individuals transitioning from nursing homes to community–based living. Partnerships exist with state and local governmental agencies, health homes, care coordination organizations, and human service providers among others. Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers   Fidelis, VNA Nascentia, Senior Network Health    
RiseBoro Community Partnership Chris Leto 917–9937241 cleto@riseboro.org riseboro.org Kings (mostly) queens, NYC, Bronx (soon) Community based organization that has a Home Care program, Assisted Living, Wellness Rising: works on Food and Nutrition, Farmers Markets and an asthma program. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Rockland Paramedic Services, Inc. Raymond Florida 845–627–8612 rflorida@rocklandparamedics.org   Rockland County Emergency Medical Services and Crisis Behavioral Health Services Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   CHP    
Rosa Lee Young Childhood Center Jeannine Rey (516) 536–5674 rlyjrey@aol.com www.rosaleeyoungchildhoodcenter.org Nassau Early childhood Education and Child Care Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
RUPCO, Inc. Kelsey Vargas 845–331–2140 x218 kvargas@rupco.org https://rupco.org/ Ulster, Greene, Dutchess Section 8 Distribution, Affordable/Sustainable Residential Housing support, Targeted Populations: Aging in Place, Young Adult, Homeless. Partnerships: OFA, OTDA, local Ulster/Dutchess NGOs, CoC Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Rural Health Network of SCNY, Inc. John C. Salo 607–692–7669 jsalo@rhnscny.org https://rhnscny.org/ All programs: Broome, Tioga, Delaware; Some programs: Chemung, Chenango, Cortland, Otsego, Tompkins, Schuyler, Steuben Rural Health Network of SCNY provides SDH services to rural Medicaid members through the Getthere call center (transportation information, education, Medicaid vouchers), the Food and Health Network (food security, nutrition, local food systems, Farm to School, Fruit and Vegetable Prescription program), Community Health Workers (outreach, screening for SDH needs, patient activation and goal setting, hospital discharges, care transitions, other referrals), and Community Health Education (health literacy, evidence–based interventions, rural cultural competency). We also address social determinants related to mental and behavioral health, including substance use disorder. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Excellus, Fidelis Care, UnitedHealthcare    
Rural Outreach Center Frank Cerny (716) 474–4194 frank.cerny@verizon.net http://theroc.co Erie, Wyoming, Alleghany, Cattaraugus ROC programs break the negative cycle of generational poverty, as Participants of all ages direct their own path to self–sufficiency. An array of services are offered to meet the multiple, complex needs of the rural population. Our model of empowerment resulted in more than 50% of engaged participants improving their housing and emotional health status in 2018. Most come to the ROC after hearing about our services from someone who has been helped. Others come to us through our community outreach programs (snack pack, back pack, winter readiness). Immediate needs are assessed and resources accessed – Department of Social Services, utility companies, food pantries, etc. Once stabilized they are asked if they would like to participate in our programs to move themselves away from dependency – from the situations that brought them to the ROC. Should they wish to become engaged, they participate in an examination process where they set life goals that become part of an agreement where they agree to work toward those goals and the ROC agrees to provide the resources they will need. Adult Participants then enter ROC U that provides opportunities to work on factors that perpetuate poverty; see below for outcome measures. ROC U offers opportunities they need to attain their goals. Virtually all start with a budget examination and development of a financial plan. This determines if the ROC will have to make resources available to them and, if so, how many. Resources include: habit examination, parenting, relationships, nutrition/cooking, etc., repairing dysfunctional relationships, home organization, civic engagement, developing socialization skills, etc. Earned incentives include many of those listed below in our program listing. Kids ROC is a parallel program for school age children. Based on the Josephson´s Institute Character Counts model, participants engage in activities that develop trustworthiness, caring, responsibility, fairness, respect and citizenship. When they show evidence of appropriate activities, they get a stamp in their passport and earn ROC bucks that can be redeemed for movie tickets, books, shopping opportunities. Play therapy is available for children who have experienced severe trauma. Babies ROC is a pilot program for children from infancy through 5 years. Toddlers and their parents participate in weekly support communities for formal and informal information exchange. Children from 3 to 6 receive scholarships to preschool programs in addition to the community. All children will be eligible for Theraplay. Outcome Measures Our outcome measures are based on the National County Health Rankings, that assume that 80% of morbidity and mortality is affected by the social determinants of health – those opportunities that the ROC provide to change lives.Most come to the ROC after hearing about our services from someone who has been helped. Others come to us through our community outreach programs (snack pack, back pack, winter readiness). Immediate needs are assessed and resources accessed – Department of Social Services, utility companies, food pantries, etc. Once stabilized they are asked if they would like to participate in our programs to move themselves away from dependency – from the situations that brought them to the ROC. Should they wish to become engaged, they participate in an examination process where they set life goals that become part of an agreement where they agree to work toward those goals and the ROC agrees to provide the resources they will need. Adult Participants then enter ROC U that provides opportunities to work on factors that perpetuate poverty; see below for outcome measures. ROC U offers opportunities they need to attain their goals. Virtually all start with a budget examination and development of a financial plan. This determines if the ROC will have to make resources available to them and, if so, how many. Resources include: habit examination, parenting, relationships, nutrition/cooking, etc., repairing dysfunctional relationships, home organization, civic engagement, developing socialization skills, etc. Earned incentives include many of those listed below in our program listing. Kids ROC is a parallel program for school age children. Based on the Josephson´s Institute Character Counts model, participants engage in activities that develop trustworthiness, caring, responsibility, fairness, respect and citizenship. When they show evidence of appropriate activities, they get a stamp in their passport and earn ROC bucks that can be redeemed for movie tickets, books, shopping opportunities. Play therapy is available for children who have experienced severe trauma. Babies ROC is a pilot program for children from infancy through 5 years. Toddlers and their parents participate in weekly support communities for formal and informal information exchange. Children from 3 to 6 receive scholarships to preschool programs in addition to the community. All children will be eligible for Theraplay. Outcome Measures: Our outcome measures are based on the National County Health Rankings, that assume that 80% of morbidity and mortality is affected by the social determinants of health – those opportunities that the ROC provide to change lives. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Safe Inc. of Schenectady Shannon Keon 518–374–0166 safeinc@nycap.rr.com www.safeincofschenectady.org Mainly Schenectady County but have also worked with Albany County, Saratoga County, Rensselaer County, Fulton/Montogmery Counties, Safe of Schenectady has two programs: Project Safe and Safe House. Project Safe is an outpatient program for individuals ages 12–35 years old. Project Safe offers a Life Skills Program, Aftercare Program, Street Outreach Program and a Safe Harbour Program (Human Trafficking). Safe House is a 30 day emergency youth shelter for ages 16–20. Safe House can also house a youth with and infant/toddler. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Medicaid    
Saint James Church Lake James Krueger (607) 832–4401 saintjames@delhitel.net www.saintjamesld.org Delaware Seniors at risk for social isolation Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Unknown    
SCAN New York Renee Avery Renee Avery Renee38135@aol.com www.scanny.org New York Case Management, Substance Abuse Treatment, Prevention, Food Pantry Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Renee Avery Health First, Blue Cross/Blue Shield,    
Schenectady County Chapter, NYSARC, Inc. Mark Sheehan (518) 410–1322 marks@sarcny.org www.arcschenectady.org Schenectady Schenectady ARC offers a wide variety of services including residential, Article 16 and 28 (social work, psychiatry, primary medical services), day services and employment Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   Medicaid – uncertain of specific health plan    
Schenectady Inner City Ministry Sharon Carter 518–331–7341 sharonc@sicm.us www.sicm.us Schenectady SiCM addresses food insecurity, nutrition and hunger by operating the largest Food Pantry in the County and is the only county–wide, summer–long, Summer Food Service provider : the largest Food Pantry in the County; the only county–wide, summer long – and offers the only diversity education program in Schenectady Co. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Schoharie County Office for the Aging Nancy Dingee 518–295–2001 Nancy.Dingee@co.schoharie.ny.us www.schohariecounty–ny.gov/ Schoharie Services are provided primarily to Older Adults under a non–medical model. Services include Home Delivered and Congregate Meals, Case Management, In–Home Contact and Support, Application Assistance, Health Insurance Counseling for Medicare, Outreach, Legal Assistance, Transportation, Nutrition Education and Counseling, and Health Promotion classes. Unsure   CDPHP, Empire    
Seaway Valley Prevention Council Larry Calkins 315 713–4861 lcalkins@svpc.net SVPC.net St. Lawrence Substance Use Disorders Prevention Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Selfhelp Community Services, Inc Russell Lusak (212) 971–7707 rlusak@selfhelp.net www.selfhelp.net The Bronx, Manhattan, Queens, Brooklyn, Nassau, and Suffolk Home and Community Based Services through social services and home care to independent older adults and "at–risk" individuals. Social Workers bring entitlements and benefits that impact the SDH in our clients´ private residences, our affordable housing, or senior centers. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   Empire Blue Cross Blue Shield VNS Choice Healthfirst
Seneca County Community Counseling Center Margaret Morse (315) 539–1980 mmorse@co.seneca.ny.us   Seneca Vocational Support/Counseling/ Case Management, Case Management, Transportation, Health Monitoring, Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Integrity Partners, Inc. United Healthcare MVP Excellus
Services for the UnderServed Erin Palmer 646–565–5802 epalmer@sus.org   Bronx, Kings, Richmond, Nassau, Suffolk, Queens, New York Housing and other supports for people with behavioral health issues and/or I/DD, veterans, domestic violence survivors and others who are homless, poor and/or recently released from incarceration/hospitalization Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency CBC HealthFirst Metroplus United
Settlement Health Mali Trilla (212) 360–2661 mtrilla@settlementhealth.org   All NYC counties Primary ambulatory health services, case management Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   HealthFirst    
Sheltering Arms Jane Golden 212–886–5688 jgolden@shelteringarmsny.org www.shelteringarmsny.org Bronx, New York, Queens, Kings Mental health services; Children and Family Treatment and Support Services; Foster Care health and mental health clinic Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Collaborative for Children and Families (CCF); AsOne      
Shiloh Consulting LLC Kay Jackson (212) 564–7631 shilohconsultingllc@gmail.com shilohconsultingllc@gmail.com Bronx, Manhattan, Queens, Staten Island, Westchester, Brooklyn Behavioral healthcare to individuals who have been involved in diverse forms of intimate aggression. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency BHNYC IPA . Also we are a for profit organization. Healthfirst Beacon  
Sidney EMS David Reynolds 607 265–3258 dvreynolds@stny.rr.com   Broome, Chenango, Delaware, Otsego We work with Sidney Catholic Charities on access to healthcare Unsure        
Skills Unlimited Matthew Collins 516–870–1600 x1862 mcollins@familyres.org skillsunlimited.org Suffolk Employment, PROS, Mental Health Clinic Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency AHN United Healthcare Beacon Health First
South Asian Council for Social Services Rehan Mehmood (718) 321–7929 rehan@sacssny.org www.sacssny.org Queens, Brooklyn, the Bornx, Manhattan, Staten Island, Nassau and Suffolk SACSS focuses on three key areas of healthcare access, education and advocacy, senior support services and food security. Our target population includes South Asians and other immigrants. We assist individuals and families with enrollment into health insurance, resolving any post enrollment issues, benefit programs like SNAP, Medicare Savings Program, Access a Ride, reduced metro cards, SCRIE, DRIE, etc. SACSS also started the first South Asian Food Pantry which provides culturally palatable food. We also conduct outreach and health literacy events throughout NYC. Through our Senior support program, we offer an array of services to the Seniors like senior movie night, Senior day, healthy breakfast and lunch on Wednesdays, trips to historical places in NYC, focus groups, individual and supportive counselling, workshops on social and emotional wellness. We also provide ESOL and Computer classes and carry out activities around civic engagement. All our services are free and are provided by culturally competent s Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks Communities Together for Health Equity (CTHE), https://cthe.us Health First Metroplus Fidelis Care
Southern Tier AIDS Program, Inc. Michelle McElroy 607–798–1721 mmcelroy@stapinc.org www.stapinc.org Broome, Chenango, Chemung, Cortland, Delaware, Otsego, Tioga, Tompkins syringe exchange services/harm reduction services, housing, care management, treatment adherence, behavioral health education, prevention services, point of care HIV/HCV/STD testing, Health Hub for People Who Use Drugs, re–entry services, prison education services & transitional planning, navigation & linkage services to primary care, behavioral health & benefits/entitlements, etc. Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers   Fidelis, Molina, CDPHP, Excellus, MVP, New York Quality Health Care, United HealthCare,    
Southern Tier Health Care System, Inc. Donna Kahm (716) 372–0614 dkahm@sthcs.org www.sthcs.org Allegany, Cattaraugus and Chautauqua STHCS is a rural health networkdesignated by the NYS Department of Health. Our collaborating partners include area hospitals, physician groups, county health departments, home care providers and ambulatory medical services. We work with community partners to build programs and initiatives based on local needs. ​Our ever–evolving programs include the Southern Tier Emergency Medical System (STEMS), Southern Tier Overdose Prevention Program (STOPP) and Sexual Assault Forensic Examiner (SAFE) program. Respectively, these cornerstones train and credential a network of 93 local EMS agencies, provide overdose resources and education, and care for survivors of sexual assault. We offer navigation assistance for those seeking affordable health insurance and also to caregivers of older adults. We administer a regional Cribs for Kids program to give infant safe–sleep education and safe cribs to people in need. Our Stop the Bleed campaign provides community training and equipment to treat life–threatening bleeding emergencies. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Fidelis YourCare BlueCross BlueShield
SPCC (Society for the Protection & Care of Children) Clarice Lazary 585–325–6101 ext 237 clazary@spcc–roch.org   Monroe, Wayne, Yates, Seneca, Ontario Preventive programs for families at risk of child abuse and neglect Unsure   Excellus    
St. Christopher´s Inn Terri Udolf (845) 335–1109 tudolf@atonementfriars.org   Putnam Housing – homeless shelter, SUD services Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency CBHS Fidelis MVP HealthFirst
St. Joseph´s Neighborhood Center Candice Lucas (585585) 325–5260 clucas@sjncenter.org   Monroe and surrounding counties We serve the uninsured and the underinsured for primary care, mental health counseling, dental, and specialty care. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks Healthy Community Alliance – Upstate CBO Consortium Excellus MVP YourCare
St. Lawrence County Health Initiative, Inc. Anne Marie Snell 315–261–4760 anne@gethealthyslc.org gethealthyslc.org St. Lawrence, Lewis, Jefferson, Oswego, Evidenced Based Interventions (Chronic Disease Self Management, Diabetes Prevention, etc), Adolescent Pregnancy Prevention, Health Insurance Enrollment, Cancer Screening Services, Adirondack Wellness Connections Coordinated Network Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Fidelis United Health Care  
Starbridge Services, Inc. Terry O´Hare 585–224–7204 tohare@starbridgeinc.org www.starbridgeinc.org Monroe, Wayne, Ontario, Livingston, Wyoming, Genesee, Orleans, as well as others in the Finger Lakes & Western NY region (depending on program) Starbridge supports people with disabilities and their families to connect with education, employment, residential, advocacy, healthy living, and fiscal intermediary supports and services. Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers Person Centered Services IPA Blue Choice, Fidelis Care, MVP Health Plan    
Staten Island PPS c (917) 830–1140 achen@statenislandpps.org   c c Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Steuben Co OFA Patty Baroody (607) 664–2298 PBaroody@SteubenCountyNY.gov   Steuben County SCOFA has served consumers of all ages and all income levels for almost 40 years. We provide information and assistance and program–specific services both directly and through contracts. Transportation, the number one need identified, is offered in a variety of cost–effective ways utilizing volunteers and paid drivers. Senior nutrition is offered through home delivered meals and congregate meal settings. Our EISEP Home care program offers non–medical in home services with a high rate of success in preventing unnecessary hospitalizations and facility placement. One of our fastest growing programs is the health insurance and benefits assistance program helping the confused consumer navigate through complex systems. NYCONNECTS is the aging and disabilities resource center for information and referrals on all LTC services and supports for all ages, mandated in each county since 2007. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
SUNY – University Eye Center Richard Soden 212 938 5761 rsoden@sunyopt.edu sunyopt.edu New York Signing people uo for healthcare Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   Affinity Metroplus Emblem
The Albany Damien Center, Inc. Perry Junjulas (1518449) 711–9102 perryj@albanydamiencenter.org http://www.albanydamiencenter.org Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Green, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, and Washington Counties. We provide services for persons living with and affected by HIV and AIDS. Our services include housing, food/meals, medication access/adherence, behavioral health counseling, social activities, drop–in community center, HIV/STD/HVC testing and access to care, employment, assistance with pets, access to primary care Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks Alliance for Better Health IPA CDPHP MVP Fidelis
The Arc Mid–Hudson Dr. Nancy Dib 845–338–1234 x42732 Nancy.Dib@ArcMH.org www.ArcMH.org Greene, Putnam, and Ulster The Arc Mid–Hudson provides services and supports for people with intellectual and developmental disabilities. We support children through our 2 preschools and various community–based services. The majority of the people we support are adults with I/DD. We offer supervised and supportive living arrangements, work–training opportunities, day programs, volunteer opportunities, and we run an Article 16 clinic that offers clinical services to the IDD population. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency        
The Arc of Livingston–Wyoming Lynn Fleming 585–658–2828 ext 106 lfleming@lwarc.org www.lwarc.org Livingston, Wyoming, Steuben, Ontario, Genesee, Monroe All services provided by the Arc of Livingston–Wyoming address various SDH for the NY Medicaid population. These services include residential, community habilitation, prevocational and vocational services, day habilitation, ISS housing subsidies, preschool and Headstart, clinical services, Family support services, recreation, respite, transportation, self advocacy, and self direction . Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Person Centered Services MVP, Excellus    
The Center for Family Support, Inc. Steven Vernikoff 212–629–7939 svernikoff@cfsny.org www.cfsny.org All 5 boroughs in NYC, Nassau, Suffolk & Westchester Counties in New York State and in the State of New Jersey Residential and Habilitative support for people with I/DD Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   HIP, HealthPlus, HealthFirst    
The Door Carolyn Glaser 212–453–0212 carolyn@door.org www.door.org New York, Queens, Brooklyn, Bronx, Staten Island Housing Support, Career Services, Education Services, Medical Services, Counseling, Meals, Legal Services, Family Planning and Sexual Health Care, Arts and Athletics Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency HUB      
The Family Center Jan Hudis 718–230–1379 x. 124 jhudis@thefamilycenter.org www.thefamilycenter.org Kings, New York, Queens, Bronx mental health services including 3 evidence based child trauma treatment modalities including Trauma Focused–Cognitive Behavioral Therapy (TF–CBT), Parent Child Interaction Therapy (PCIT), and Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS); Specialized services for Unaccompanied Alien Children;Specialized services for grandparents and others raising children who are not their biological children including Parenting Support employing 3 evidence Parenting Curricula including Resource Parent Curriculum: Raising Children Exposed to Trauma (RPC), Positive Parenting Program (Triple P ) and Parenting Journey); Specialized Civil Legal Services for families impacted by illness Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency        
The Family Counseling Center Michael Countryman (518) 725–4310 mcountryman@thefamilycounselingcenter.org www.thefamilycounselingcenter.org Fulton, Montgomery Behavioral Health, Support for Domestic Violence Victims, Health Coaching, Mental Health Crisis Intervention, Family Peer Support, Respite, Children´s Case Management Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   New York Quality Healthcare Corporation    
The Food Pantries for the Capital District, Inc. Natasha Pernicka (518) 458–1167 natasha@thefoodpantries.org www.thefoodpantries.org Albany, Rensselaer, Saratoga, Schenectady Food Insecurity, Food Assistance, Healthy Food, Fresh Produce, Service Coordination, Network of Food Assistance Providers, Referral Services, Data Tracking Software System, Streamlined Referral and Connection, Medically Tailored Meals, Medically Tailored Food, Food Delivery, Food Pantry. The Food Pantries is a network of more than 67 food pantries and partners working together to end hunger. Our network serves 57,000 individuals in the New York Capital Region. Enough food is provided for more than 3.2 million meals annually. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks Healthy Together IPA      
The Institute for Family Health Carol Bouton 845–255–3766 cbouton@institute.org www.institute.org Bronx, Brooklyn, Dutchess, New York, Ulster Primary medical care, mental health care, dental care and social support services including care coordination, insurance enrollment and benefits assistance. We participate in three New York State performing provider systems (PPS) as well as an ACO and an IPA. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Community Health IPA (https://www.communityhealthipa.com/) HealthFirst    
The Interfaith Nutrition Network, Inc. (The INN) Joanne Robinson 516 534 2810 jrobinson@the–inn.org www.the–inn.org Nassau County All free services: Hot daily meals, showers, food pantry, computer lab, assistance w ID documents, government benefits, housing and employment, transportation, mental health services Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   united, health first, fidelis    
The Jewish Board of Family and Children´s Services Diane Novy (212) 632–4615 dnovy@jbfcs.org www.jbfcs.org Bronx, Kings, New York, Queens, Richmond and Westchester Housing, behavioral health Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency CBC IPA Healthfirst    
The League Treatment Center (DBA League Education and Treatment Center) Mark Handelman 718–643–5300 X342 mhandelman@leaguecenter.org www.leaguecenter.org Citywide Special Education and Mental Health services for seriously emotionally disturbed children and youth and Day Habilitation for Developmentally Delayed Adults Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   Not sure    
The Lesbian, Gay, Bisexual & Transgender Community Center Antonio Ruberto Jr (646) 556–9296 aruberto@gaycenter.org www.gaycenter.org New York, Bronx, Kings, Queens, Richmond We have two OASAS–licensed outpatient substance use treatment programs, one for ages 13–25 and one for ages 26 and up. Both are designed specifically for the LGBT population. We also offer free HIV testing M–F from 12–4pm, in addition to PEP/PrEP linkage and navigation, short–term mental health counseling, TGNC counseling and support groups along with case management, and an expansive youth program with groups and internships five–days–a–week, including a drop–in space from 3–7:30pm. We also are a NYS insurance enrollment provider. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Bailey House MetroPlus    
The National Witness Project, Inc. Dee Johnson (716) 845–1394 thenationalwitnessproject@gmail.com nationalwitnessproject.org Western New York The National Witness Project, Inc. is a National Cancer Institute and a Research Test Intervention program listed on Cancer Control Planet.Gov (http://cancercontrolplanet.cancer.gov/index.html). The National Witness Project, Inc.´s goals are to assist low and non utilizer with access to affordable preventative care and wellness services ie.community outreach services, culturally tailored education programs, navigation services for preventive health screening and Transportation. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   YourCARE Health Plan Blue Cross Blue Shield Independent Health Association, Inc.
The New York Foundling Sylvia Rowlands 212–660–1313 sylvia.rowlands@nyfoundling.org NYFoundling.org NY, Bronx, Kings, Richmond, Queens, Westchester, Rockland, Orange Educational advocacy, Criminal Justice Services, Health Care, Behavioral Health Care including SUD text, prevent maltreatment, domestic violence trx/prevention, housing services, Early Head Start/Head Start, college retention, academic tutoring, bilingual health/behavioral services, home–based health services, community development, disproportionality in residential/criminal justice, Health Home Care Management, temporary and permanent supported housing. We partner with 52 other CBOs, are Foundling members of a BHCC and Health Home Collaborative. We have two strategic partnerships with small CBOs service niche populations – African, Arab, Middle Eastern, I/DD, Foster Care Children & Hearing Impaired. We target "complex family systems" for services. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency AsOne Healthcare & Collaborative for Children and Families HealthFirst    
The Newburgh Ministry, Inc. Colin Jarvis (845) 561–0700 cjarvis@newburghministry.org newburghministry.org Orange Homeless and homeless prevention services Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   United Healthcare MVP Healthplans Affinity Health Plan, Crystal Run Health Plan
The Partnership for Ontario County Tracey Dello Stritto (585) 396–4554 partnershipforontariocountyed@gmail.com www.partnershipforontariocounty.org Ontario County Prevention services for substance abuse (focused on community engagement and schools) / Free counseling, support groups and wellness initiatives for those in recovery (substance use and mental health recovery and over 18 years of age) Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks CBO Consortium of Upstate New York      
The Partnership for the Homeless N/A N/A N/A https://partnershipforthehomeless.org New York county, Bronx county, Kings county, Queens county, Richmond county Eviction prevention services (rental assistance, landlord/tenant mediation, housing related legal referrals), voucher–based housing placement services, HIV/AIDS health education, health service navigation, peer support Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Healthfirst PHSP, Amida Care, MetroPlus    
The Salvation Army Linda Wright 315–434–1360 Linda.Wright@use.salvationarmy.org www.salvationarmyempirestate.org/ all 48 Upstate New York Counties provides services to address food insecurity, socialization, behavioral health, child care, housing/shelter, family services, employment, spiritual care/pastoral care, homeless prevention, child welfare services and clinical support Tier 2: Non–profit, Medicaid billing, non–clinical service providers. E.g. transportation providers, care coordination providers        
Tioga County Rural Ministry Alycia Anthony (607)687–3021 aanthony@tcrm.org www.tcrm.org Tioga County, NY Food Pantry, Financial Assistance for housing, utilities, car repair, car insurance, prescriptions, etc., Ramp Building and Minor Repairs, Holiday Food Baskets, Spring Cleanup for Seniors, Christmas Clothing Gifts, Back to School Clothing for Teens, Personal Products, Nutrition Classes Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Fidelis, CDPHP, United Healthcare    
Transitional Living Services of Northern New York Maureen Cean (315) 782–1777 mcean@tlsnny.com www.tlsnny.com Jefferson, Lewis, St. Lawrence TLS works with populations who have issues with mental health, homelessness, or living with chronic diseases. We are a licensed provider of residential and clinic programming through OMH. We are also a provider a homeless and supportive housing. We are a health home care management provider assisting people with chronic health conditions. We are also a provider of HCBS services. Adults and children are both served. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency We are part of a health care IPA formed under DSRIP and a BHCC. UHC Fidelis Excellus
Transitional Services for New York, Inc. Daniel Donoghue (718) 746–6647 ddonoghue@tsiny.org www.tsiny.org Queens, Brooklyn, Bronx, Nassau, TSINY provides support to over 3,000 New York City residents with a mental illness each year. We are a safety net provider and primarily serve the Medicaid enrolled population. We offer a full range of behavioral health programs including our Clinic, PROS, Mobile Outreach, Care Management, HCBS services, Employment Services, Educational Supports, Adult Protective Services, Rapid Response Mobile Crisis Team, Crisis Respite Center, Peer Run Empowerment Center and over 700 units of housing ranging from Supervised Community Residences to Supported Housing. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   Healthfirst Affinity MetroPlus, Fidelis
TRI Center Inc Joe Gonzalez 212–268–8830 Tricenter@msn.com   Bronx,Kings, New York Out–patient drug treatment services, CMA CASE MANAGEMENT, HCBS and HARP services, Recovery Coach academy. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   Health First Affinity Beacon United Healthcare Community Plan
Trillium Health, Inc Donna Leone 585–210–4125 dleone@trilliumhealth.org www.trilliumhealth.org Monroe, Wayne, Ontario, Livingston, Stueben, Schuyler, Yates, Seneca, Chemung Trillium Health provides comprehensive, integrated, primary and specialty health care services, supportive services and care management, prevention, education and testing, harm reduction and syringe access services to the Greater Rochester/Finger Lakes Region. Trillium Health provides these services to address health disparities and improve outcomes of at–risk communities, including racial and ethnic minorities, LGBTQ populations, and individuals and families living in poverty. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Accountable Health Partners, https://ahpnetwork.com/ Excellus Health Plan    
Trinity Alliance of the Capital Region Harris Oberlander (518) 449–5155 h.oberlander@ta–cr.org trinityalliancealbany.org Albany, Schenectady, Rensselaer We have three program divisions (health and wellness, community based network services, alternatives to incarceration). We address micro and macro level social determinants to promote holistic wellness (services include housing navigation, social support services, early childhood intervention, food pantry, foster care prevention, gun violence prevention, substance use treatment facility) Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Healthy Alliance IPA, Capital Behavioral Health Network CDPHP    
Truth Pharm Alexis Pleus 607–245–6878 alexis@truthpharm.org   Broome, Chenango, Delaware, Madison, Tioga, Chemung, Tompkins Addiction, Harm Reduction, Food, Hygiene, Housing, Healthcare, Incarceration, Re–entry, Social Justice Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Excellus Fidellis MVP
Union Settlement Association, Inc. David Nocenti (212) 828–6046 dnocenti@unionsettlement.org www.unionsettlement.org New York County (Manhattan) Union Settlement is the oldest and largest social service provider in East Harlem, which is a neighborhood rich in culture and diversity, but also one of the lowest–income communities in New York City. We are both an on–the–ground resource for East Harlem residents of all ages, and a strong advocate for the needs of underserved communities. Since opening our doors in 1895, Union Settlement has brought a wide range of education, wellness and community–building programs to this community. Our current services include: • Early childhood education • Youth afterschool and summer programs • College preparation • Job readiness • Programs for disconnected and court–involved youth • Adult education (including ESOL, HSE and citizenship classes) • Mental health counseling • Senior centers • Meals on Wheels • Small business assistance We provide services to approximately 10,000 individuals every year from more than a dozen locations in East Harlem. Our services are designed to support the needs of every generation and culture, and we are also a strong advocate for underserved communities in New York City and beyond. Union Settlement is also one of the largest employers in East Harlem, with a staff of over 350 dedicated employees, and we also have the wonderful support of scores of volunteers. Together, we help give the residents we serve the skills, tools and education they need to build better lives for themselves and their families. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency We are a participating provider in the Coordinated Behavioral Care (CBC) IPA      
United Cerebral Palsy of New York City d/b/a ADAPT Community Network Mariette McBride 212 683–6700 ext 1117 mmcbride@ucpnyc.org adaptcommunitynetwork.org Manhattan, Bronx, Queens, Kings, Richmond, Suffolk Health Care Centers, Article 16 clinics, residential and day habilitation programs Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency        
Unity House of Troy. Inc. Linda Lewis 518–274–2607 ext 4180 Llewis@unityhouseny.org www.unityhouseny.org Primarily Rensselear, but also Albany, Schenectady, Saratoga dedicated to enhancing the quality of life for People living in poverty, adults with mental illness, victims of domestic violence, children with deverlopmental delays, people living with HIV/AIDS, and others whose needs can be effectively met by Unity House services and philosophy Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Behavioral Health Care Collaborative CDPHP FIDELIS  
University Settlement Mary Adams (212) 453–4505 marya@door.org www.universitysettlement.org New York City – Manhattan, Brooklyn, Bronx Services available for ages 0 – older adults. English, Spanish and Chinese. Family child care, early childhood education, after school, entitlement counseling, housing stability and eviction prevention, food support, literacy programs, arts programming, parenting support programs/services Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Collaborative Behavioral Care (CBC) www.cbcare.org Healthfirst, Metroplus, Fidelis,    
Vanderheyden Barbara Cataldo 518–283–6500 X719 bcataldo@vanderheyden.org www.vanderheyden.org Albany, Renssealer, Schenectady, Fulton, Montgomery, Columbia, Greene, Herkimer, Saratoga, Schoharie, Warren and Washington Hard to Place youth, Children and Family Treatment and Support Services, Foster care sevices, OPWDD sevices, HCBS services, Supervised Independent Living Services and Health Home Services Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Capital Behavioral Health Network https://cbhnetwork.com CDPHP Fidelis United
Venture House Inc. Leila McCarthy (347) 396–6670 lmmcarthy1@health.nyc.gov https://www1.nyc.gov/site/doh/index.page Richmond County We are a mental health psycho–social rehabilitation clubhouse, serving adults diagnosed with a serious mental illness. We assist our members with housing, education, and vocational services, as well as providing a familial atmosphere so people feel they belong to a community that will support them in achieving their goals and not judge them. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks CBC IPA      
VIBS Family Violence and Rape Crisis Center Reina Schiffrin 631–360–3730 rschiffrin@vibs.org vibs.org Suffolk County Counseling, Advocacy, Legal, 24/7 Hotline, Case Management , Education for victims of domestic and sexual violence. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Victor Orlando Woolson Foundation, Inc. n/a n/a n/a www.vow–foundation.org Oswego County, Regionally, State and Country Education about synthetic drugs, addiction & Mental Health Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Villa of Hope Ruby Cosme 585–865–1550 ext. 284 ruby.cosme@villaofhope.org www.villaofhope.org Monroe, Wayne, Ontario, Orleans, Genesee, Livingston Services we provide are Children & Family Treatment Support Services, Home & Community Bases Servcies for Adulth and Children, Adulth Health Home, Children´s Helath Home, Outpatient SUD Clinic, Outpatient Integrated Clinic, Inpatient RRSY, CD Prevention, Peer Mentor, NYSED Part 853 Day School. Partnerships with DHS Monroe County, Bivona Child Advocacy Center, and Seven School Districts for Integrated Outpatient Services. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Rochester Planning Consortium and Behvavioral Health Care Collaborative Excellus Blue Choice Option    
VISIONS/Services for the Blind and Visually Impaired Nancy D Miller 212–219–4071 nmiller@visionsvcb.org   Bronx, Kings, Nassau, New York, Queens, Richmond, Rockland, Suffolk, Westchester in–home training for independence for legally blind and severely visually persons of all ages and their families and unpaid caregivers; falls prevention through orientation and mobility training; training for providing child care or elder care with limited vision or no vision; combatting social isolation with congregate programs offering meals, socialization, evidence based programs for blind older persons (NYC only); workforce and job placement services for legally blind persons; pre–employment services for blind high school graduates that are disconnected youth (not in school and not working) Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
VNSNY Home Care Jessica Williams 212–609–5051 jessica.williams@vnsny.org www.vnsny.org New York, Queens, Kings, Bronx, Richmond, Nassau, Suffolk, Westchester • VNSNY´s Care Management Organization (CMO) offers comprehensive complex care management which addresses clinical, behavioral health, social determinants, and advanced illness needs. Key to this care management model is engagement of paraprofessional health coaches who conduct health literacy and serve as community navigators. The CMO conducts SDH risk assessments, stratification and uses search engine technology (like Healthify) to link individuals to services to address economic instability, housing instability, food insecurity, family/community support, and health literacy. • PEARLS conducts outreach and home–based evidence–based treatment to address social isolation and depression for seniors 65+. • Parachute provides a continuum of evidence–based services for high utilizers of institutional settings. An interdisciplinary team provides six to nine months of in–home treatment, serving as a bridge to a stable and multifaceted outpatient aftercare plan. Services include: outreach, crisis intervention, in–home psychiatric and medical assessment and treatment, in–home individual and family therapeutic services based on care plan, medication management and support, peer support, network meetings for participants and families/caregivers (NATM), rehabilitation support, and care management. • Working closely with young, low–income, first–time mothers—nearly half of whom are teenagers—and their babies in the Bronx and Nassau County, VNSNY´s Nurse–Family Partnership breaks the cycle of poverty and improves the future for both the mother and her family. NFP pairs mothers with a specially trained nurse who meets regularly with the mother from pregnancy through the child´s second birthday. The nurse monitors the mother´s and child´s health, encourages mother–child interactions (such as reading aloud) that enhance the baby´s development, and helps the mother plan for her child´s future and pursue her own education and career goals. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency CBC IPA United Healthcare    
Vocational Instruction Project Community Service Anna Otero 718–589–5150 aotero@vipservices.org https://vipservices.org/ Bronx VIP offers integrated medical, behavioral health, housing, and wrap–around services to improve the health and well being of the Bronx and surrounding communities Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency   Fidelis, Health first, and Metroplus    
Wayne Behavioral Health Network – County of Wayne James Haitz (315) 946–5725 jhaitz@co.wayne.ny.us   Wayne also Monroe, Ontario, Seneca, Orleans, Wyoming, Genesee, Yates, Livingston We provide a full aray of mental health and substance use outpatient clinic treatment and support services. We also operate a Regional Open Access Center & COTI Mobile Response Service. Care management is also provided. Psychosocial Program is available. Forensic and jail based services. 31 School based mental health clinics. We also function and as the LGU for the Dept of Mental Health for Wayne County. Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Integrity Partners for Behavioral Health IPA, Inc. Excellus Health Plan Fidelis Care United Health Care
WellLife Network Sherry Tucker 718–559–0516 sherry.tucker@welllifenetwork.org www.welllifenetwork.org Queens, Kings, Bronx, Nassau, Suffolk housing, food pantry, transportation education, clinical services, money management, life and social skills, health education, Tier 3: Non–profit, Medicaid billing, clinical and clinical support service provider; licensed by a State agency Coordinated Behavioral Care (www.cbcare.org/ and Advanced Health Network (www.ahn–ipa.com) Beacon    
Western New York Integrated Care Collaborative Nikki Kmicinski (716) 887–2749 nkmicinski@wnyicc.org www.wnyicc.org Erie, Niagara, Cattaraugus, Orleans, Wyoming, Genesee, Allegheny and soon Chautauqua We provide community–based programs such as in–home care management, chronic disease self–management program, diabetes self–management program, diabetes prevention program, and can help partner with additional CBOs to offer more services according to the needs of the community and the health plans. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks Western New York Integrated Care Collaborative      
WHMC MICHC Program Eleanor Juray 718–963–7545 ejuray@wyckoffhospital.org   Kings WHMC´s MICHC program aims to improve maternal and infant health outcomes. We aim to accomplish this by empowering and promoting women to seek knowledge in maintaining healthy behaviors across a reproductive life span Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Empire Blue Cross Blue Shield Health First Fedelis Care
WIB Inc. dba Chautauqua Works Katie Geise 716–487–5116 kgeise@chautauquaworks.com www.chautauquaworks.com Chautauqua Assist job seekers in finding employment and assist businesses in filling their open positions. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
WNY Rural AHEC Valerie Putney 585–787–6275 vputney@r–ahec.org www.r–ahec.org Allegany, Cattaraugus, Chautauqua, Genesee, Livingston, Monroe, Ontario, Orleans, Steuben, Wayne, Wyoming, Yates We offer trainings to the healthcare workforce that increases their knowledge of SDH, how to recognize it, and how to direct customers to services. We are presently designing classes for care coordinators which will give them skills to advance their careers. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   we don´t provide direct services to the medicaid population    
Women´s Prison Association Wendy Eberhardt 646–50–7859 weberhardt@wpaonline.org   All NYC Counties WPA provides a range of services for women with or at risk for criminal justice system involvement including case management, alternatives to incarceration, employment support and placement, legal assistance in family law and other civil matters, HIV prevention services including testing, prevention services for families with child welfare system involvement, and housing for homeless women and families Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks        
Youth Action Programs and Homes, Inc. Robert Taylor (212) 860–8170 rtaylor@yayb.org www.youthaction.nyc New York, Kings, Bronx, and Queens Counties High School Equivalency and Post Secondary Education, Vocational Skills training, Wrap Around and Workforce Development services. Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks   Not sure    
YWCA Cortland Kelly Tobin 607–753–9651 kelly@cortlandywca.org www.cortlandywca.org Cortland and surrounding Mentoring, Child Care, Victims Services and Health and Fitness Tier 1: Non–profit, non–Medicaid billing. E.g. housing, social services, religious organizations, food banks