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General NPI Number Information
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NPI Number | 1568776102
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Entity Type | Organization
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Legal Business Name | CIRCLE OF FRIENDS
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Dates
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Enumeration Date | 08/05/2010
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Last Update Date | 08/05/2010
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Provider Practice Location Address
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Address Line | 2 BETHLEHEM CT
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City | DELMAR
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State | NY
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Zip | 12054-1306
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Country | US
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Telephone | 518-478-0722
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Fax |
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Provider Business Mailing Address
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Address Line | 2 BETHLEHEM CT
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City | DELMAR
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State | NY
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Zip | 12054-1306
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Country | US
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Telephone | 518-478-0722
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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 | MRS. ALICE KEARSE
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Credential | SLP, MS
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Telephone | 518-478-0722
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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 | 005495-1
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License Number State | NY
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