Provider Demographics
NPI:1396398368
Name:THERAPEUTIC IMPRINTS OT, PT, SLP, LMSW, PSYCHOLOGY, PLLC
Entity Type:Organization
Organization Name:THERAPEUTIC IMPRINTS OT, PT, SLP, LMSW, PSYCHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:PEREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTR/L
Authorized Official - Phone:718-409-6977
Mailing Address - Street 1:3265 JOHNSON AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3539
Mailing Address - Country:US
Mailing Address - Phone:718-409-6977
Mailing Address - Fax:718-684-2811
Practice Address - Street 1:3265 JOHNSON AVE STE 302
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3539
Practice Address - Country:US
Practice Address - Phone:718-409-6977
Practice Address - Fax:718-684-2811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management