Healthcare Provider Details

I. General information

NPI: 1801031430
Provider Name (Legal Business Name): NORTH SHORE KIDS TALK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 COMMUNITY DR STE 302
MANHASSET NY
11030-3820
US

IV. Provider business mailing address

29 ETON RD
NEW HYDE PARK NY
11040-2047
US

V. Phone/Fax

Practice location:
  • Phone: 516-850-2133
  • Fax:
Mailing address:
  • Phone: 516-850-2133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number011429-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. TINA LISA CIACCIO
Title or Position: DIRECTOR
Credential: MA CCC-SLP
Phone: 516-850-2133