MEDICARE: CTJ TOUCH OF LOVE. INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency	04788-1	NY

General Provider Information

NPI Number	:	1144770868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CTJ TOUCH OF LOVE. INC

Provider Business Mailing Address
First Line	:	1212 OGDEN AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452-3541
Country	:	US
Telephone Number	:	646-391-4544
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 OGDEN AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452-3541
Country	:	US
Telephone Number	:	646-391-4544
Fax Number	:

Authorized Official
Title or Position	:	SOCIAL WORKER
Name	:	MISS CONNCETTA BERNICE JOHNSON
Credential	:	LICENSE MASTER OF SO
Telephone Number	:	646-391-4544

Provider Enumeration Date	:	10/05/2016
Last Update Date	:	10/05/2016

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