Provider Demographics
NPI:1134604440
Name:EXTRAORDINARY BEINGS
Entity type:Organization
Organization Name:EXTRAORDINARY BEINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ABA THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGETTE
Authorized Official - Middle Name:SEMONE
Authorized Official - Last Name:EDMUND
Authorized Official - Suffix:
Authorized Official - Credentials:MS SPED
Authorized Official - Phone:917-498-0767
Mailing Address - Street 1:1511 ROYCE ST APT 3I
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5877
Mailing Address - Country:US
Mailing Address - Phone:917-498-0767
Mailing Address - Fax:
Practice Address - Street 1:1511 ROYCE ST APT 3I
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5877
Practice Address - Country:US
Practice Address - Phone:917-498-0767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1962817452OtherNPI