Organization
BAKER VICTORY
Active
Other names
ChildPro
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER POVINELLI (SPECIAL EDUCATION THERAPIST)
(716) 909-5662
Entity
Organization
Contact information
Practice address
697 RIDGE RD, LACKAWANNA, NY 14218-1500
(716) 822-4781
(716) 825-5765
Mailing address
697 RIDGE RD, LACKAWANNA, NY 14218-1500
(716) 822-4781
(716) 825-5765
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
1127815
NY
Other
Enumeration date
07/10/2012
Last updated
07/10/2012
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