Organization
EARLY INTERVENTION LCSW SERVICES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBORAH LYNNE HARADON LCSW (PRESIDENT)
(845) 485-7237
Entity
Organization
Contact information
Practice address
220 ROGERS ST, ULSTER PARK, NY 12487-5015
(845) 485-7237
Mailing address
220 ROGERS ST, ULSTER PARK, NY 12487-5015
(845) 339-2462
(845) 339-2462
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
04126401
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03552105
—
NY
Enumeration date
01/29/2018
Last updated
01/29/2018
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