Provider Demographics
NPI:1194968289
Name:EXCALIBER CONSULTING INC.
Entity type:Organization
Organization Name:EXCALIBER CONSULTING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ALVAREZ
Authorized Official - Last Name:KIERAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC - SLP
Authorized Official - Phone:516-521-2726
Mailing Address - Street 1:115 SPLIT OAK DR
Mailing Address - Street 2:
Mailing Address - City:EAST NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:11732-1146
Mailing Address - Country:US
Mailing Address - Phone:516-521-2726
Mailing Address - Fax:
Practice Address - Street 1:115 SPLIT OAK DR
Practice Address - Street 2:
Practice Address - City:EAST NORWICH
Practice Address - State:NY
Practice Address - Zip Code:11732-1146
Practice Address - Country:US
Practice Address - Phone:516-521-2726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency