Healthcare Provider Details

I. General information

NPI: 1356994297
Provider Name (Legal Business Name): EMMANUELLA VOLCY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date: 02/10/2020
Reactivation Date: 03/18/2020

III. Provider practice location address

23 ECKERSON LN
SPRING VALLEY NY
10977-3131
US

IV. Provider business mailing address

23 ECKERSON LN
SPRING VALLEY NY
10977-3131
US

V. Phone/Fax

Practice location:
  • Phone: 845-731-9245
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: