Provider Demographics
NPI:1215190822
Name:FORDHAM TREMONT
Entity Type:Organization
Organization Name:FORDHAM TREMONT
Other - Org Name:LAIS PROGRAM
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERIA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:718-960-0200
Mailing Address - Street 1:2021 GRAND CONCOURSE
Mailing Address - Street 2:FORDHAM TREMONT - LAIS PROGRAM
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-4304
Mailing Address - Country:US
Mailing Address - Phone:718-960-0200
Mailing Address - Fax:
Practice Address - Street 1:2021 GRAND CONCOURSE
Practice Address - Street 2:FORDHAM TREMONT - LAIS PROGRAM
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4304
Practice Address - Country:US
Practice Address - Phone:718-960-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13174012251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management