# MOLDING YOUNG MINDS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962063073
- **Authorized official:** MS. JILLANN MICHELLE LEWIS MS (SOLE MEMBER/OWNER)
- **Authorized official phone:** (917) 592-2506

## Contact information

- **Practice address:** 311 NEW YORK AVE, LINDENHURST, NY 11757-3306
- **Practice address phone:** (917) 592-2506
- **Mailing address:** 311 NEW YORK AVE, LINDENHURST, NY 11757-3306
- **Mailing address phone:** (917) 592-2506

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 252Y00000X | Early Intervention Provider Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 06/28/2019
- **Last updated:** 06/28/2019