Organization
LARIDIAN KOINONIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JASON CALDERON (PRESIDENT)
(505) 203-7689
Entity
Organization
Contact information
Practice address
8115 5TH AVE, BROOKLYN, NY 11209-4102
(718) 218-4442
Mailing address
3050 PERRY AVE APT 3D, BRONX, NY 10467-4130
(718) 218-4442
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
177F00000X
Lodging Provider
Primary
—
—
Other
Enumeration date
05/12/2020
Last updated
05/12/2020
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