Provider Demographics
NPI:1760628754
Name:BUILDING BLOCKS LEARNING CENTER,LLC
Entity Type:Organization
Organization Name:BUILDING BLOCKS LEARNING CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PULEO O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-SLP
Authorized Official - Phone:315-853-6090
Mailing Address - Street 1:2 FOUNTAIN STREET
Mailing Address - Street 2:SUITE 109
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323
Mailing Address - Country:US
Mailing Address - Phone:315-853-6090
Mailing Address - Fax:315-853-3190
Practice Address - Street 1:2 FOUNTAIN ST
Practice Address - Street 2:SUITE 109
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1725
Practice Address - Country:US
Practice Address - Phone:315-853-6090
Practice Address - Fax:315-853-3190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008027-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency