Healthcare Provider Details

I. General information

NPI: 1235976689
Provider Name (Legal Business Name): MILDRED R AMADOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 07/12/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 JEROME AVE
BX NY
10453
US

IV. Provider business mailing address

2105 JEROME AVE AUTISM CARE PARTNERS -BRONX CENTER
BX NY
10453
US

V. Phone/Fax

Practice location:
  • Phone: 718-769-2698
  • Fax:
Mailing address:
  • Phone: 718-769-2698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: