Provider Demographics
NPI:1134482664
Name:THERACARE
Entity Type:Organization
Organization Name:THERACARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ABA THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FAIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-239-1048
Mailing Address - Street 1:1160 THROGGMORTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1429
Mailing Address - Country:US
Mailing Address - Phone:718-239-1048
Mailing Address - Fax:
Practice Address - Street 1:1160 THROGGMORTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1429
Practice Address - Country:US
Practice Address - Phone:718-239-1048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY700656252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency