Provider Demographics
NPI:1992135917
Name:BOOTHE ALCINDOR, BERNICE (MS-SPECIAL ED)
Entity type:Individual
Prefix:MRS
First Name:BERNICE
Middle Name:
Last Name:BOOTHE ALCINDOR
Suffix:
Gender:F
Credentials:MS-SPECIAL ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1098 EAST 58TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234
Mailing Address - Country:US
Mailing Address - Phone:718-763-4213
Mailing Address - Fax:718-763-4213
Practice Address - Street 1:1098 EAST 58TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234
Practice Address - Country:US
Practice Address - Phone:718-763-4213
Practice Address - Fax:718-763-4213
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCH162940252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency