Provider Demographics
NPI:1811746662
Name:ADAPTIVE ADVENTURES INC
Entity type:Organization
Organization Name:ADAPTIVE ADVENTURES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEIT/ABA PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MAHINAKHON
Authorized Official - Middle Name:
Authorized Official - Last Name:QODIROVA
Authorized Official - Suffix:
Authorized Official - Credentials:MSSPED
Authorized Official - Phone:646-457-5375
Mailing Address - Street 1:2331 E 23RD ST APT 1F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4815
Mailing Address - Country:US
Mailing Address - Phone:646-457-5375
Mailing Address - Fax:
Practice Address - Street 1:2331 E 23RD ST APT 1F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4815
Practice Address - Country:US
Practice Address - Phone:646-457-5375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health