Provider Demographics
NPI:1528189057
Name:UNITED CEREBRAL PALSY
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:718-442-6006
Mailing Address - Street 1:265 TRANTOR PL
Mailing Address - Street 2:APT 1
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-1942
Mailing Address - Country:US
Mailing Address - Phone:718-442-8876
Mailing Address - Fax:
Practice Address - Street 1:281 PORT RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-1707
Practice Address - Country:US
Practice Address - Phone:718-442-8876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0680001251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services