Provider Demographics
NPI:1801158407
Name:INSTITUTE FOR CHILDHOOD EDUCATION AND FAMILY SERVICE
Entity type:Organization
Organization Name:INSTITUTE FOR CHILDHOOD EDUCATION AND FAMILY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:VITULLI
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BA, MA
Authorized Official - Phone:718-526-6125
Mailing Address - Street 1:92-21 165TH STREET
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-1103
Mailing Address - Country:US
Mailing Address - Phone:718-526-6125
Mailing Address - Fax:718-526-9629
Practice Address - Street 1:92-21 165TH STREET
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-1103
Practice Address - Country:US
Practice Address - Phone:718-526-6125
Practice Address - Fax:718-526-9629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02209676251S00000X
NY02351875251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03253096Medicaid
NY03412397Medicaid