Provider Demographics
NPI:1316717275
Name:TIME TO SHINE LICENSED BEHAVIOR ANALYSIS PLLC
Entity type:Organization
Organization Name:TIME TO SHINE LICENSED BEHAVIOR ANALYSIS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEARL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDWURM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-585-0713
Mailing Address - Street 1:557 GRAND CONCOURSE STE 3-221
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-5253
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:557 GRAND CONCOURSE STE 3-221
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5253
Practice Address - Country:US
Practice Address - Phone:347-585-0713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center