Provider Demographics
NPI:1073157681
Name:POISED ONDEMAND-PROMOTING OPULENCE IN SOCIAL EMOTIONAL DEVELOPMENT LLC
Entity Type:Organization
Organization Name:POISED ONDEMAND-PROMOTING OPULENCE IN SOCIAL EMOTIONAL DEVELOPMENT LLC
Other - Org Name:POISED ONDEMAND LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:BEHAVIOR HEALTH PROF
Authorized Official - Phone:914-507-7576
Mailing Address - Street 1:5 UNION SQ W # 1471
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3306
Mailing Address - Country:US
Mailing Address - Phone:914-507-7576
Mailing Address - Fax:833-699-4702
Practice Address - Street 1:POISED ONDEMAND-PROMTOING OPULENCE IN SOCIAL EMOTIONAL
Practice Address - Street 2:800 THIRD AVENUE, FRNT A #1306
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022
Practice Address - Country:US
Practice Address - Phone:914-885-5093
Practice Address - Fax:833-699-4702
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POISED ONDEMAND-PROMOTING OPULENCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-06
Last Update Date:2023-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or CharitableGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06368170Medicaid