Healthcare Provider Details

I. General information

NPI: 1740611029
Provider Name (Legal Business Name): 123 LEARN TO SPEAK, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 85TH ST 4F
BROOKLYN NY
11209-4717
US

IV. Provider business mailing address

488 85TH ST 4F
BROOKLYN NY
11209
US

V. Phone/Fax

Practice location:
  • Phone: 718-207-0959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number001205-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MADONNA BONNY
Title or Position: EARLY INTERVENTIONIST
Credential: MS. ED
Phone: 718-207-0959