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General NPI Number Information
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NPI Number | 1528489135
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Entity Type | Organization
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Legal Business Name | COLLABORATIVE LEARNING SERVICES
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Dates
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Enumeration Date | 12/27/2013
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Last Update Date | 12/27/2013
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Provider Practice Location Address
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Address Line | 94 GILLIES LN
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City | NORWALK
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State | CT
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Zip | 06854-1058
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Country | US
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Telephone | 203-216-3108
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Fax |
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Provider Business Mailing Address
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Address Line | 94 GILLIES LN
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City | NORWALK
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State | CT
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Zip | 06854-1058
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Country | US
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Telephone | 203-216-3108
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARY DOMINGUEZ
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Credential |
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Telephone | 203-216-3108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State | NY
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