Healthcare Provider Details

I. General information

NPI: 1205773504
Provider Name (Legal Business Name): 1ST STEPS EARLY INTERVENTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 SUMPTER ST
BROOKLYN NY
11233-2545
US

IV. Provider business mailing address

348 SUMPTER ST
BROOKLYN NY
11233-2545
US

V. Phone/Fax

Practice location:
  • Phone: 718-281-6496
  • Fax:
Mailing address:
  • Phone: 718-281-6496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: DIAMOND MACK
Title or Position: CO-FOUNDER
Credential:
Phone: 718-281-6496