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General NPI Number Information
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NPI Number | 1326396532
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Entity Type | Individual
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Provider Name | MINDY LEE COOLIDGE MSED, BCBA, LBA
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Gender | Female
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Dates
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Enumeration Date | 08/20/2012
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 120 E 73RD ST APT 1B
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City | NEW YORK
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State | NY
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Zip | 10021-4259
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Country | US
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Telephone | 518-570-8101
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Fax |
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Provider Business Mailing Address
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Address Line | 717 WESTCHESTER AVE
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City | RYE BROOK
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State | NY
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Zip | 10573-1346
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Country | US
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Telephone | 518-570-8101
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 001415
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License Number State | NY
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