Provider Demographics
NPI:1790079838
Name:TAY TAY MAC EVALUATIONS & THERAPY
Entity Type:Organization
Organization Name:TAY TAY MAC EVALUATIONS & THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAMETTREE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCELVEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-974-6364
Mailing Address - Street 1:650 BUTTRICK AVE. 2C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2625
Mailing Address - Country:US
Mailing Address - Phone:718-974-6364
Mailing Address - Fax:
Practice Address - Street 1:650 BUTTRICK AVE. 2C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2625
Practice Address - Country:US
Practice Address - Phone:718-974-6364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency