Provider Demographics
NPI:1912458548
Name:DEFINING MOMENTS, LLC
Entity type:Organization
Organization Name:DEFINING MOMENTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:GIULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PREZIUSO
Authorized Official - Suffix:
Authorized Official - Credentials:MHC
Authorized Official - Phone:201-618-1400
Mailing Address - Street 1:125 WICKHAM AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-3759
Mailing Address - Country:US
Mailing Address - Phone:845-343-2499
Mailing Address - Fax:
Practice Address - Street 1:125 WICKHAM AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-3759
Practice Address - Country:US
Practice Address - Phone:845-343-2499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18007521101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty