Provider Demographics
NPI:1912141722
Name:LONG ISLAND DEVELOPMENTAL CONSULTING, INC
Entity Type:Organization
Organization Name:LONG ISLAND DEVELOPMENTAL CONSULTING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MULCAHY-WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:MSED, SDA, BCBA
Authorized Official - Phone:631-285-6400
Mailing Address - Street 1:1355 STONY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2203
Mailing Address - Country:US
Mailing Address - Phone:631-285-6400
Mailing Address - Fax:631-285-6523
Practice Address - Street 1:1355 STONY BROOK RD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2203
Practice Address - Country:US
Practice Address - Phone:631-285-6400
Practice Address - Fax:631-285-6523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency