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General NPI Number Information
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NPI Number | 1972925212
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Entity Type | Organization
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Legal Business Name | GAEA AUTISM INC.
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Dates
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Enumeration Date | 01/06/2014
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Last Update Date | 01/14/2014
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Provider Practice Location Address
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Address Line | 226 WHEELER AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10314-5112
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Country | US
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Telephone | 646-372-7073
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Fax |
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Provider Business Mailing Address
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Address Line | 226 WHEELER AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10314-5112
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Country | US
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Telephone | 646-372-7073
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | RACHEL ANNE LUNDEN-CARTER
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Credential | MS SPED
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Telephone | 646-372-7073
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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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