Organization
RED DOOR INDIVIDUALIZED LEARNING PROGRAM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGORY DOMOND (PRESIDENT)
(516) 654-8600
Entity
Organization
Contact information
Practice address
30 W COLUMBIA ST, HEMPSTEAD, NY 11550-2411
(516) 385-2323
(516) 481-4201
Mailing address
30 W COLUMBIA ST, HEMPSTEAD, NY 11550-2411
(516) 385-2323
(516) 481-4201
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
09/16/2021
Last updated
09/16/2021
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