Provider Demographics
NPI:1417328337
Name:EARLY INTERVENTION LLC
Entity Type:Organization
Organization Name:EARLY INTERVENTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:TSHH, TSE, SDA
Authorized Official - Phone:888-320-5550
Mailing Address - Street 1:42 LAKE AVENUE EXT
Mailing Address - Street 2:#286
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-5279
Mailing Address - Country:US
Mailing Address - Phone:888-320-5550
Mailing Address - Fax:516-706-1962
Practice Address - Street 1:42 LAKE AVENUE EXT
Practice Address - Street 2:#286
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-5279
Practice Address - Country:US
Practice Address - Phone:888-320-5550
Practice Address - Fax:516-706-1962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY16022252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency