Healthcare Provider Details

I. General information

NPI: 1851603096
Provider Name (Legal Business Name): HUDSON VALLEY YOUNG ACHIEVERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2010
Last Update Date: 07/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 COLT CT
GOSHEN NY
10924-1201
US

IV. Provider business mailing address

PO BOX 609
GOSHEN NY
10924-0609
US

V. Phone/Fax

Practice location:
  • Phone: 914-589-2054
  • Fax:
Mailing address:
  • Phone: 914-589-2054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-09-6391
License Number StateNY

VIII. Authorized Official

Name: MRS. ADRIENNE M MAVIGLIA
Title or Position: EXECUTIVE DIRECTOR
Credential: BCBA
Phone: 914-589-2054