MEDICARE: YOUNG MINDS @ PLAY

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		NY

General Provider Information

NPI Number	:	1265973440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNG MINDS @ PLAY

Provider Business Mailing Address
First Line	:	436 NEW YORK AVENUE
Second Line	:	F9
City	:	BROOKLYN
State	:	NY
Zip	:	11225
Country	:	US
Telephone Number	:	347-297-1201
Fax Number	:

Provider Business Practice Location Address
First Line	:	436 NEW YORK AVE
Second Line	:	F9
City	:	BROOKLYN
State	:	NY
Zip	:	11225-3250
Country	:	US
Telephone Number	:	347-297-1201
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOANNE JOSEPH
Credential	:	MS ED
Telephone Number	:	347-522-8388

Provider Enumeration Date	:	03/20/2017
Last Update Date	:	03/20/2017

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Directions to “YOUNG MINDS @ PLAY ” Practice Location

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