Provider Demographics
NPI:1861635450
Name:ST. MARY'S HOSPITAL FOR CHILDREN
Entity Type:Organization
Organization Name:ST. MARY'S HOSPITAL FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:AYALA-PAPPAGEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MASTER DEGREE
Authorized Official - Phone:914-375-7605
Mailing Address - Street 1:33 OLD HEMLOCK DR
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-7249
Mailing Address - Country:US
Mailing Address - Phone:845-567-3398
Mailing Address - Fax:845-567-3398
Practice Address - Street 1:33 OLD HEMLOCK DR
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-7249
Practice Address - Country:US
Practice Address - Phone:845-567-3398
Practice Address - Fax:845-567-3398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-12
Last Update Date:2009-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071446-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency