| NPI | 1750107546 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WIDNA TAVERAS Licensed Behavior 646-296-9221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251T00000X PACE Provider Organization |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency |
| Enumeration Date | 2024-11-26 |
| Last Update Date | 2025-07-30 |