Healthcare Provider Details

I. General information

NPI: 1790360139
Provider Name (Legal Business Name): ACADEMY FOR YOUNG MINDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 03/17/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 46TH RD
LONG ISLAND CITY NY
11101-5322
US

IV. Provider business mailing address

1133 WESTCHESTER AVE STE N-230
WHITE PLAINS NY
10604-3522
US

V. Phone/Fax

Practice location:
  • Phone: 646-670-5999
  • Fax: 212-564-2578
Mailing address:
  • Phone: 212-564-2350
  • Fax: 212-564-2578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN CALDERON
Title or Position: PRESIDENT, BOARD OF TRUSTEES
Credential:
Phone: 212-564-2354