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General NPI Number Information
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NPI Number | 1245166271
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Entity Type | Organization
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Legal Business Name | MAGIC MILESTONES BEHAVIORAL SERVICE LLC
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Dates
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Enumeration Date | 06/18/2026
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Last Update Date | 06/18/2026
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Provider Practice Location Address
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Address Line | 36 W CHELTEN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19144-2702
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Country | US
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Telephone | 267-882-6388
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Fax |
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Provider Business Mailing Address
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Address Line | 4843 PULASKI AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19144-4128
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Country | US
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Telephone | 267-882-6388
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ANTOINETTE COOPER-EDNEY
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Credential |
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Telephone | 267-882-6388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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