=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487888277
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY RESOURCES OF NEW YORK, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2009
-----------------------------------------------------
Last Update Date | 05/07/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 352 WEST 117TH STREET, SUITE 4D
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10026-1558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-316-0829
-----------------------------------------------------
Fax | 212-678-0411
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 352 WEST 117TH STREET, SUITE 4D
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10026-1558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-316-0829
-----------------------------------------------------
Fax | 212-678-0411
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/MANAGER
-----------------------------------------------------
Name | MS. ROSALIND V. WILSON
-----------------------------------------------------
Credential | MSSW
-----------------------------------------------------
Telephone | 212-316-0829
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number | 036141-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------