Healthcare Provider Details

I. General information

NPI: 1750130548
Provider Name (Legal Business Name): ELEVATED KIDS NY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 NOVEMBER WALK
LONG BEACH NY
11561-2935
US

IV. Provider business mailing address

100 CREST CT
WEDDINGTON NC
28104-5626
US

V. Phone/Fax

Practice location:
  • Phone: 516-216-9992
  • Fax: 704-389-3193
Mailing address:
  • Phone: 516-216-9992
  • Fax: 704-389-3193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: AMBERLY CABALLERO
Title or Position: CEO
Credential:
Phone: 267-978-4305