Provider Demographics
NPI:1861756389
Name:KRYSIAK, ANETA KATARZYNA (MSED,BCBA)
Entity type:Individual
Prefix:MISS
First Name:ANETA
Middle Name:KATARZYNA
Last Name:KRYSIAK
Suffix:
Gender:F
Credentials:MSED,BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9944 67TH RD
Mailing Address - Street 2:3C
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3049
Mailing Address - Country:US
Mailing Address - Phone:917-951-6751
Mailing Address - Fax:
Practice Address - Street 1:9944 67TH RD
Practice Address - Street 2:3C
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3049
Practice Address - Country:US
Practice Address - Phone:917-951-6751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-14-17329103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst