Provider Demographics
NPI:1699166017
Name:RD#1 WERNER RD LTD
Entity type:Organization
Organization Name:RD#1 WERNER RD LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:518-664-5066
Mailing Address - Street 1:4 FAIRCHILD SQ
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-1254
Mailing Address - Country:US
Mailing Address - Phone:518-664-5066
Mailing Address - Fax:518-664-5782
Practice Address - Street 1:4 FAIRCHILD SQ
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-1254
Practice Address - Country:US
Practice Address - Phone:518-664-5066
Practice Address - Fax:518-664-5782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY520302880126251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services