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Provider Information for 1669759130

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1669759130

Calendar   Last Updated:  2011-11-10
  Certification Date: 


Name Value
NPI 1669759130
Enumeration Date 2011-11-10
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 20 ROLLINS ST APT 2E
YONKERS, NY 10705-4362
United States

Phone: 718-450-7716 | Fax:
View Map External Link
Primary Practice Address 5050 ISELIN AVE
BRONX, NY 10471-2915
United States

Phone: 718-549-6700 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 322D00000X - Residential Treatment Facility, Emotionally Disturbed Children