Provider Demographics
NPI:1518465277
Name:EARLY INTERVENTION LCSW SERVICES PC
Entity Type:Organization
Organization Name:EARLY INTERVENTION LCSW SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:HARADON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:845-485-7237
Mailing Address - Street 1:220 ROGERS ST
Mailing Address - Street 2:
Mailing Address - City:ULSTER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12487-5015
Mailing Address - Country:US
Mailing Address - Phone:845-339-2462
Mailing Address - Fax:845-339-2462
Practice Address - Street 1:220 ROGERS ST
Practice Address - Street 2:
Practice Address - City:ULSTER PARK
Practice Address - State:NY
Practice Address - Zip Code:12487-5015
Practice Address - Country:US
Practice Address - Phone:845-485-7237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04126401251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03552105Medicaid