Provider Demographics
NPI:1083953228
Name:DESIRE-CHARLES, NINECHINE (MS IN SPECIAL EDUCA)
Entity Type:Individual
Prefix:
First Name:NINECHINE
Middle Name:
Last Name:DESIRE-CHARLES
Suffix:
Gender:F
Credentials:MS IN SPECIAL EDUCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PETERS LN
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-3122
Mailing Address - Country:US
Mailing Address - Phone:786-800-4476
Mailing Address - Fax:
Practice Address - Street 1:3 PETERS LN
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-3122
Practice Address - Country:US
Practice Address - Phone:786-800-4476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1719137252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency