Provider Demographics
NPI:1558649293
Name:PROACTIVE SPEECH AND LANGUAGE P.C.
Entity Type:Organization
Organization Name:PROACTIVE SPEECH AND LANGUAGE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-828-8258
Mailing Address - Street 1:18 GARDENIA RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-2725
Mailing Address - Country:US
Mailing Address - Phone:631-828-8258
Mailing Address - Fax:631-474-7821
Practice Address - Street 1:18 GARDENIA RD
Practice Address - Street 2:
Practice Address - City:MOUNT SINAI
Practice Address - State:NY
Practice Address - Zip Code:11766-2725
Practice Address - Country:US
Practice Address - Phone:631-828-8258
Practice Address - Fax:631-474-7821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0115821252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency