Provider Demographics
NPI:1346900925
Name:BOLD ARROW LICENSED BEHAVIOR ANALYST PC
Entity type:Organization
Organization Name:BOLD ARROW LICENSED BEHAVIOR ANALYST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YITZCHAK
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBART
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:718-222-5999
Mailing Address - Street 1:6 LAURA DR
Mailing Address - Street 2:
Mailing Address - City:AIRMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10952-3402
Mailing Address - Country:US
Mailing Address - Phone:718-222-5999
Mailing Address - Fax:718-387-6429
Practice Address - Street 1:6 LAURA DR
Practice Address - Street 2:
Practice Address - City:AIRMONT
Practice Address - State:NY
Practice Address - Zip Code:10952-3402
Practice Address - Country:US
Practice Address - Phone:718-222-5999
Practice Address - Fax:718-387-6429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty