Provider Demographics
NPI:1750057477
Name:POISED ONDEMAND-PROMOTING OPULENCE IN SOCIAL EMOTIONAL DEVELOPMENT LIM
Entity Type:Organization
Organization Name:POISED ONDEMAND-PROMOTING OPULENCE IN SOCIAL EMOTIONAL DEVELOPMENT LIM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS PSYCHOLOGY
Authorized Official - Phone:914-885-5093
Mailing Address - Street 1:649 BRONX RIVER ROAD
Mailing Address - Street 2:3R
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704
Mailing Address - Country:US
Mailing Address - Phone:914-885-5093
Mailing Address - Fax:
Practice Address - Street 1:649 BRONX RIVER ROAD
Practice Address - Street 2:3R
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704
Practice Address - Country:US
Practice Address - Phone:914-885-5093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-22
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06368170Medicaid