Healthcare Provider Details

I. General information

NPI: 1902153141
Provider Name (Legal Business Name): THE 13TH CHILD AUTISM & BEHAVIORAL COACHING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8346 118TH ST SUITE 2H
KEW GARDENS NY
11415-2370
US

IV. Provider business mailing address

8346 118TH ST SUITE 2H
KEW GARDENS NY
11415-2370
US

V. Phone/Fax

Practice location:
  • Phone: 718-316-8057
  • Fax:
Mailing address:
  • Phone: 718-316-8057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1893773
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number893773
License Number StateNY

VIII. Authorized Official

Name: MISS REBECCA M MCKEE
Title or Position: OWNER, CONSULTANT
Credential: MSED ACBA
Phone: 718-316-8057