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General NPI Number Information
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NPI Number | 1063861227
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Entity Type | Organization
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Legal Business Name | ILLUMINATING STEPS, LLC
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 06/08/2016
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Provider Practice Location Address
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Address Line | 1 DEER PATH
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-4616
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Country | US
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Telephone | 631-987-3043
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Fax |
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Provider Business Mailing Address
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Address Line | 1 DEER PATH
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-4616
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | RENEE LEE
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Credential |
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Telephone | 631-987-3043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 000145
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License Number State | NY
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