MEDICARE: MS. CHEVANESE V GRANT MS SPECIAL EDUCATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	2588463	NY

General Provider Information

NPI Number	:	1801519756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHEVANESE V GRANT MS SPECIAL EDUCATION

Provider Business Mailing Address
First Line	:	30 GLENWOOD AVE
Second Line	:
City	:	NEW ROCHELLE
State	:	NY
Zip	:	10801-3602
Country	:	US
Telephone Number	:	914-336-1512
Fax Number	:

Provider Business Practice Location Address
First Line	:	1336 LOUIS NINE BLVD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10459-1535
Country	:	US
Telephone Number	:	718-991-2119
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2022
Last Update Date	:	09/26/2022

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