Healthcare Provider Details

I. General information

NPI: 1720527351
Provider Name (Legal Business Name): CARES BDDC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 GRAND ST 2ND FLOOR
NEW YORK NY
10002-4800
US

IV. Provider business mailing address

465 GRAND ST 2ND FLOOR
NEW YORK NY
10002-4800
US

V. Phone/Fax

Practice location:
  • Phone: 211-420-1970
  • Fax:
Mailing address:
  • Phone: 211-420-1970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: BETH STATFELD
Title or Position: CFO
Credential:
Phone: 212-420-1970