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General NPI Number Information
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NPI Number | 1811554512
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Entity Type | Organization
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Legal Business Name | CHILDREN SERVICES BROADEN, LLC
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Dates
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Enumeration Date | 05/29/2019
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Last Update Date | 05/29/2019
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Provider Practice Location Address
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Address Line | 1838 CHOWAN ST
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City | ELMONT
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State | NY
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Zip | 11003-1741
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Country | US
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Telephone | 631-743-0159
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 30633
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City | ELMONT
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State | NY
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Zip | 11003-0633
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Country | US
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Telephone | 347-515-9014
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Fax |
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Authorized Official
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Title or Position | SPECIAL INSTRUCTOR
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Name | MS. SHIRLEY SIMS
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Credential | MSED
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Telephone | 631-743-0159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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