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General NPI Number Information
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NPI Number | 1962795716
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Entity Type | Organization
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Legal Business Name | NEW HOPE: PHYSICAL SPEECH OCCUPATIONAL AND LMSW SERVICES PLLC
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Dates
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Enumeration Date | 05/25/2011
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Last Update Date | 05/25/2011
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Provider Practice Location Address
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Address Line | 27 CATHERINE ST
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-1318
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Country | US
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Telephone | 631-261-9145
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Fax | 631-262-9145
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Provider Business Mailing Address
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Address Line | 7 FENWICK ST
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City | GREENLAWN
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State | NY
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Zip | 11740-1405
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Country | US
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Telephone | 631-757-4063
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Fax | 631-757-4063
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Authorized Official
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Title or Position | SECRETARY/TREASURER MGR MBR
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Name | MS. DIANE CEPEDA AMANTIA
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Credential | P.T.
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Telephone | 631-757-4063
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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 | 0111231
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License Number State | NY
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