Organization
ABUNDANT LIFE AGENCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JOHANN ANDREA RICHARDSON (SERVICE COORDINATOR)
(718) 735-7151
Entity
Organization
Contact information
Practice address
827 CLARKSON AVE, BROOKLYN, NY 11203-2256
(718) 735-7151
(718) 735-7141
Mailing address
827 CLARKSON AVE, BROOKLYN, NY 11203-2256
(718) 735-7151
(718) 735-7141
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
21900
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1992903736
—
NY
Enumeration date
08/03/2012
Last updated
08/03/2012
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