Provider Demographics
NPI:1083123756
Name:BROOKLYN ART INCUBATOR, INC.
Entity Type:Organization
Organization Name:BROOKLYN ART INCUBATOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:PROF
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC, CASAC
Authorized Official - Phone:718-208-0526
Mailing Address - Street 1:PO BOX 20648
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11202-0648
Mailing Address - Country:US
Mailing Address - Phone:718-208-0526
Mailing Address - Fax:
Practice Address - Street 1:1311 PACIFIC ST APT 206
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-4591
Practice Address - Country:US
Practice Address - Phone:718-208-0526
Practice Address - Fax:347-467-2634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care