Provider Demographics
NPI:1255469896
Name:CHILDREN'S EVALUATION AND REHABILITATION CENTER - DFSU
Entity Type:Organization
Organization Name:CHILDREN'S EVALUATION AND REHABILITATION CENTER - DFSU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ANNMARIE
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:718-430-3970
Mailing Address - Street 1:1165 MORRIS PARK AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1915
Mailing Address - Country:US
Mailing Address - Phone:718-430-3970
Mailing Address - Fax:718-823-4877
Practice Address - Street 1:1165 MORRIS PARK AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1915
Practice Address - Country:US
Practice Address - Phone:718-430-3970
Practice Address - Fax:718-823-4877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067708-1273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit