Provider Demographics
NPI:1508226549
Name:D M W THERAPEUTIC SERVICES.
Entity Type:Organization
Organization Name:D M W THERAPEUTIC SERVICES.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ABA SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:718-930-9335
Mailing Address - Street 1:16A LONG BR. RD
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542
Mailing Address - Country:US
Mailing Address - Phone:718-930-9335
Mailing Address - Fax:
Practice Address - Street 1:16 LONG BR APT A
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-3262
Practice Address - Country:US
Practice Address - Phone:718-930-9335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1222386252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency