Provider Demographics
NPI:1801944665
Name:CLEARY DEAF CHILD CENTER, INC.
Entity type:Organization
Organization Name:CLEARY DEAF CHILD CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MORSEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-588-0530
Mailing Address - Street 1:301 SMITHTOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-2080
Mailing Address - Country:US
Mailing Address - Phone:631-588-0530
Mailing Address - Fax:631-588-0016
Practice Address - Street 1:301 SMITHTOWN BLVD
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-2080
Practice Address - Country:US
Practice Address - Phone:631-588-0530
Practice Address - Fax:631-588-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01479372Medicaid