Provider Demographics
NPI:1710524541
Name:THE LLEWELLYN J FORBES URBAN YOUTH INITIATIVE
Entity Type:Organization
Organization Name:THE LLEWELLYN J FORBES URBAN YOUTH INITIATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LLEWELLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FORBES
Authorized Official - Suffix:
Authorized Official - Credentials:ED M
Authorized Official - Phone:646-302-4426
Mailing Address - Street 1:PO BOX 601
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-0618
Mailing Address - Country:US
Mailing Address - Phone:646-302-4426
Mailing Address - Fax:
Practice Address - Street 1:1231 LAFAYETTE AVE
Practice Address - Street 2:BXL SUITES
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10474-5331
Practice Address - Country:US
Practice Address - Phone:646-302-4426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty