Provider Demographics
NPI:1386175719
Name:PROGRESSIVE BEHAVIOR INTERVENTIONS LICENSED BEHAVIOR ANALYST P C
Entity type:Organization
Organization Name:PROGRESSIVE BEHAVIOR INTERVENTIONS LICENSED BEHAVIOR ANALYST P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MENG YAO
Authorized Official - Middle Name:
Authorized Official - Last Name:HU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-204-5999
Mailing Address - Street 1:2511 UNION ST
Mailing Address - Street 2:6D
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-1264
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2511 UNION ST
Practice Address - Street 2:6D
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-1264
Practice Address - Country:US
Practice Address - Phone:646-204-5999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000812251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health