Provider Demographics
NPI:1235976689
Name:AMADOR, MILDRED R
Entity type:Individual
Prefix:
First Name:MILDRED
Middle Name:R
Last Name:AMADOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 JEROME AVE
Mailing Address - Street 2:AUTISM CARE PARTNERS -BRONX CENTER
Mailing Address - City:BX
Mailing Address - State:NY
Mailing Address - Zip Code:10453
Mailing Address - Country:US
Mailing Address - Phone:718-769-2698
Mailing Address - Fax:
Practice Address - Street 1:2105 JEROME AVE
Practice Address - Street 2:
Practice Address - City:BX
Practice Address - State:NY
Practice Address - Zip Code:10453
Practice Address - Country:US
Practice Address - Phone:718-769-2698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101200000XBehavioral Health & Social Service ProvidersDrama Therapist