Provider Demographics
NPI:1114369642
Name:NEIGHBORHOOD CHANGE YOUTH ORGANIZATION INC
Entity Type:Organization
Organization Name:NEIGHBORHOOD CHANGE YOUTH ORGANIZATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TAKISHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:EDUCATOR
Authorized Official - Phone:718-981-0445
Mailing Address - Street 1:88 SENECA ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-2334
Mailing Address - Country:US
Mailing Address - Phone:718-981-0445
Mailing Address - Fax:
Practice Address - Street 1:88 SENECA ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-2334
Practice Address - Country:US
Practice Address - Phone:718-981-0445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251V00000X
NY609775252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No252Y00000XAgenciesEarly Intervention Provider Agency