Provider Demographics
NPI:1346379856
Name:TAYLORMAYD, INC.
Entity Type:Organization
Organization Name:TAYLORMAYD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BULLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:BS CASAC-T
Authorized Official - Phone:718-829-3617
Mailing Address - Street 1:51 WESTCHESTER SQ
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3526
Mailing Address - Country:US
Mailing Address - Phone:718-829-3617
Mailing Address - Fax:718-829-2997
Practice Address - Street 1:51 WESTCHESTER SQ
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3526
Practice Address - Country:US
Practice Address - Phone:718-829-3617
Practice Address - Fax:718-829-2997
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
NY101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty