Provider Demographics
NPI:1700244266
Name:GOLD COAST CHILDREN'S CENTER
Entity Type:Organization
Organization Name:GOLD COAST CHILDREN'S CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDIER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA-D
Authorized Official - Phone:203-883-8827
Mailing Address - Street 1:972 POST RD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4525
Mailing Address - Country:US
Mailing Address - Phone:203-883-8827
Mailing Address - Fax:
Practice Address - Street 1:972 POST RD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4525
Practice Address - Country:US
Practice Address - Phone:203-883-8827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-29
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000411251S00000X
NY000323251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health