Basic Information
Provider Information
NPI: 1801149547
EntityType: 2
ReplacementNPI:  
OrganizationName: THERACARE EARLY INTERVENTION, LLC
LastName:  
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Mailing Information
Address1: 116 WEST 32ND ST.
Address2: 8TH FLR.
City: NEW YORK
State: NY
PostalCode: 10001
CountryCode: US
TelephoneNumber: 2125642350
FaxNumber: 2125642578
Practice Location
Address1: 116 WEST 32ND ST.
Address2: 8TH FLR.
City: NEW YORK
State: NY
PostalCode: 10001
CountryCode: US
TelephoneNumber: 2125642350
FaxNumber: 2125642578
Other Information
ProviderEnumerationDate: 10/18/2012
LastUpdateDate: 10/18/2012
NPIDeactivationReasonCode:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: CALDERON
AuthorizedOfficialFirstName: JOHN
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 2125642350
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: THERACARE OF NEW YORK, IN
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251S00000X  Y AgenciesCommunity/Behavioral Health 

No ID Information.


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