Provider Demographics
NPI:1427502939
Name:LICENSED BEHAVIOR ANALYST PROFESSIONAL SERVICES PLLC
Entity type:Organization
Organization Name:LICENSED BEHAVIOR ANALYST PROFESSIONAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YOCHEVED
Authorized Official - Middle Name:
Authorized Official - Last Name:WASSERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:845-596-2271
Mailing Address - Street 1:1326 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5754
Mailing Address - Country:US
Mailing Address - Phone:845-596-2271
Mailing Address - Fax:718-307-6406
Practice Address - Street 1:1326 E 10TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5754
Practice Address - Country:US
Practice Address - Phone:845-596-2271
Practice Address - Fax:718-307-6406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-12
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-08-4858103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty