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General NPI Number Information
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NPI Number | 1740082296
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Entity Type | Organization
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Legal Business Name | LEAD BY EXAMPLE, REVERSE THE TREND
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Dates
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Enumeration Date | 03/26/2025
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 2916 8TH AVE STE 2
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City | NEW YORK
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State | NY
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Zip | 10039-1619
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Country | US
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Telephone | 732-430-9020
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Fax |
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Provider Business Mailing Address
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Address Line | 8 W 126TH ST
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City | NEW YORK
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State | NY
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Zip | 10027-3811
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Country | US
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Telephone | 732-430-9020
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANTHONY HENDRICKSON
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Credential |
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Telephone | 732-430-9020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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