Provider Demographics
NPI:1063035657
Name:ALPHA & OMEGA KIDS DEVELOPMENTAL SERVICES
Entity Type:Organization
Organization Name:ALPHA & OMEGA KIDS DEVELOPMENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:WILMA
Authorized Official - Middle Name:IVETTE
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-424-6343
Mailing Address - Street 1:1797 PITKIN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-7841
Mailing Address - Country:US
Mailing Address - Phone:347-424-6343
Mailing Address - Fax:718-922-9202
Practice Address - Street 1:1797 PITKIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-7841
Practice Address - Country:US
Practice Address - Phone:347-424-6343
Practice Address - Fax:718-922-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty