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General NPI Number Information
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NPI Number | 1740430974
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Entity Type | Organization
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Legal Business Name | THERAPY ECT
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Dates
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Enumeration Date | 09/24/2008
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Last Update Date | 09/24/2008
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Provider Practice Location Address
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Address Line | 8442 151ST ST
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City | JAMAICA
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State | NY
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Zip | 11432-1618
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Country | US
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Telephone | 917-589-8828
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 747835
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City | REGO PARK
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State | NY
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Zip | 11374-7835
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Country | US
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Telephone | 917-589-8828
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPY DIRECTOR
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Name | MRS. SONYA ROBENOV
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Credential | MHA
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Telephone | 917-589-8828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 013793-1
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License Number State | NY
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