Provider Demographics
NPI:1417364787
Name:A FRIENDLY FACE LLC
Entity Type:Organization
Organization Name:A FRIENDLY FACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DORELIEN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:347-466-4381
Mailing Address - Street 1:228 WESTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5417
Mailing Address - Country:US
Mailing Address - Phone:347-466-4381
Mailing Address - Fax:347-466-4381
Practice Address - Street 1:228 WESTWOOD AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5417
Practice Address - Country:US
Practice Address - Phone:347-466-4381
Practice Address - Fax:347-466-4381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health