Healthcare Provider Details

I. General information

NPI: 1063288074
Provider Name (Legal Business Name): THRIVE CENTER CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 COX AVE
YONKERS NY
10704-3910
US

IV. Provider business mailing address

1767 CENTRAL PARK AVE STE 120
YONKERS NY
10710-2828
US

V. Phone/Fax

Practice location:
  • Phone: 914-693-2959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: LOURDES BLANCO
Title or Position: DIRECTOR
Credential: LCSW
Phone: 914-693-2959