Provider Demographics
NPI:1972852655
Name:EDEN II SCHOOL FOR AUTISTIC CHILDREN, INC.
Entity Type:Organization
Organization Name:EDEN II SCHOOL FOR AUTISTIC CHILDREN, INC.
Other - Org Name:EDEN II PROGRAMS
Other - Org Type:Other Name
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:MR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-816-1422
Mailing Address - Street 1:150 GRANITE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-2718
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 GRANITE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-2718
Practice Address - Country:US
Practice Address - Phone:718-816-1422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health