Healthcare Provider Details

I. General information

NPI: 1053729111
Provider Name (Legal Business Name): DYNAMIC CARE ASSOCIATE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 08/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1479 PROSPECT PL STE 2
BROOKLYN NY
11213-2490
US

IV. Provider business mailing address

1479 PROSPECT PL STE 2
BROOKLYN NY
11213-2490
US

V. Phone/Fax

Practice location:
  • Phone: 718-986-9306
  • Fax: 877-585-0047
Mailing address:
  • Phone: 718-986-9306
  • Fax: 877-585-0047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0233701
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number0233701
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0233701
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number0233701
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number0233701
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number0233701
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number0233701
License Number StateNY

VIII. Authorized Official

Name: MS. REZIA YOSHIKA LUKE
Title or Position: OWNER/SPEECH LANGAUAGE PATHOLOGIST
Credential: SLP-CCC
Phone: 718-986-9306