MEDICARE: THE INSTITUTE FOR THE DEVELOPMENT OF CHILDREN AND FAMILIES

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	070731000239	NY

General Provider Information

NPI Number	:	1154565943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE INSTITUTE FOR THE DEVELOPMENT OF CHILDREN AND FAMILIES

Provider Business Mailing Address
First Line	:	114 N 16TH ST
Second Line	:
City	:	WHEATLEY HEIGHTS
State	:	NY
Zip	:	11798-1815
Country	:	US
Telephone Number	:	516-527-7322
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 N 16TH ST
Second Line	:
City	:	WHEATLEY HEIGHTS
State	:	NY
Zip	:	11798-1815
Country	:	US
Telephone Number	:	516-527-7322
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. MICHELLE COOKE
Credential	:	LCSW-R, LMHC
Telephone Number	:	516-527-7322

Provider Enumeration Date	:	04/24/2009
Last Update Date	:	04/24/2009

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