Provider Demographics
NPI:1588116123
Name:WEISS, SHOSHANA (BCBA,MED)
Entity type:Individual
Prefix:MRS
First Name:SHOSHANA
Middle Name:
Last Name:WEISS
Suffix:
Gender:F
Credentials:BCBA,MED
Other - Prefix:MRS
Other - First Name:SHOSHANA
Other - Middle Name:
Other - Last Name:ZANZIPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1680 E 22ND ST
Mailing Address - Street 2:APT 305
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1535
Mailing Address - Country:US
Mailing Address - Phone:718-690-0434
Mailing Address - Fax:
Practice Address - Street 1:1680 E 22ND ST
Practice Address - Street 2:APT 305
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1535
Practice Address - Country:US
Practice Address - Phone:718-690-0434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst