Provider Demographics
NPI:1528486958
Name:MARRA GLICK APPLIED BEHAVIOR SOLUTIONS
Entity type:Organization
Organization Name:MARRA GLICK APPLIED BEHAVIOR SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GLICK
Authorized Official - Suffix:
Authorized Official - Credentials:MA,MED, BCBA
Authorized Official - Phone:631-479-2900
Mailing Address - Street 1:150 VETERANS MEMORIAL HWY
Mailing Address - Street 2:STE 1365
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-6503
Mailing Address - Country:US
Mailing Address - Phone:631-479-2900
Mailing Address - Fax:
Practice Address - Street 1:150 VETERANS MEMORIAL HWY
Practice Address - Street 2:STE 1365
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-6503
Practice Address - Country:US
Practice Address - Phone:631-479-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty