Provider Demographics
NPI:1548619083
Name:CMR-HEAVENLY ANGELS INC
Entity Type:Organization
Organization Name:CMR-HEAVENLY ANGELS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION TEACHER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-575-0598
Mailing Address - Street 1:2021 LITTLE BRITAIN RD
Mailing Address - Street 2:
Mailing Address - City:ROCK TAVERN
Mailing Address - State:NY
Mailing Address - Zip Code:12575-5343
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2021 LITTLE BRITAIN RD
Practice Address - Street 2:
Practice Address - City:ROCK TAVERN
Practice Address - State:NY
Practice Address - Zip Code:12575-5343
Practice Address - Country:US
Practice Address - Phone:917-575-0598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty