Provider Demographics
NPI:1710238720
Name:THE MISUNDERSTOOD YOUTH DEVELOPMENT CENTER CORPORATION
Entity Type:Organization
Organization Name:THE MISUNDERSTOOD YOUTH DEVELOPMENT CENTER CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRYL
Authorized Official - Middle Name:EBONY
Authorized Official - Last Name:DE MENDONCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-286-6769
Mailing Address - Street 1:12055 QUEENS BLVD
Mailing Address - Street 2:ROOM G-5
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11424-1015
Mailing Address - Country:US
Mailing Address - Phone:917-251-2424
Mailing Address - Fax:718-286-6750
Practice Address - Street 1:12055 QUEENS BLVD
Practice Address - Street 2:ROOM G-5
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11424-1015
Practice Address - Country:US
Practice Address - Phone:917-251-2424
Practice Address - Fax:718-286-6750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management