Provider Demographics
NPI:1528797735
Name:TEAMWORK LICENSED BEHAVIOR ANALYST SERVICES, PLLC
Entity type:Organization
Organization Name:TEAMWORK LICENSED BEHAVIOR ANALYST SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-701-4632
Mailing Address - Street 1:127 W 30TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3406
Mailing Address - Country:US
Mailing Address - Phone:646-410-5871
Mailing Address - Fax:347-619-0735
Practice Address - Street 1:127 W 30TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3406
Practice Address - Country:US
Practice Address - Phone:646-410-5871
Practice Address - Fax:347-619-0735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty