Provider Demographics
NPI:1326396532
Name:COOLIDGE, MINDY LEE (MSED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:LEE
Last Name:COOLIDGE
Suffix:
Gender:F
Credentials:MSED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-1346
Mailing Address - Country:US
Mailing Address - Phone:518-570-8101
Mailing Address - Fax:
Practice Address - Street 1:120 E 73RD ST APT 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4259
Practice Address - Country:US
Practice Address - Phone:518-570-8101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001415103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst