Organization
ACHIEVING GOALS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA GROOM MA (SPECIAL EDUCATOR)
(631) 983-7996
Entity
Organization
Contact information
Practice address
14 FIRDALE ST, CENTEREACH, NY 11720-4205
(631) 983-7996
Mailing address
14 FIRDALE ST, CENTEREACH, NY 11720-4205
(631) 983-7996
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
1914670
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
191460
TEACHING LICENCE
NY
Enumeration date
05/19/2014
Last updated
05/19/2014
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