Provider Demographics
NPI:1528730645
Name:BURTI, ROSEMARY (BCBA)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:BURTI
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1887 RICHMOND AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3923
Mailing Address - Country:US
Mailing Address - Phone:718-698-1300
Mailing Address - Fax:
Practice Address - Street 1:43 OLIVE WALK
Practice Address - Street 2:
Practice Address - City:BREEZY POINT
Practice Address - State:NY
Practice Address - Zip Code:11697-1632
Practice Address - Country:US
Practice Address - Phone:646-641-0219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-21-52981103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst