Provider Demographics
NPI:1699220186
Name:VICTORIA LUPYNOS, INC.
Entity Type:Organization
Organization Name:VICTORIA LUPYNOS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP-CCC, TSSLD-BEA
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUPYNOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-669-9318
Mailing Address - Street 1:2615 AVENUE W
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-5041
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2615 AVENUE W
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-5041
Practice Address - Country:US
Practice Address - Phone:917-669-9318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022661-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency