Provider Demographics
NPI:1992569768
Name:POTENTIAL LICENSED BEHAVIOR ANALYSTS PLLC
Entity type:Organization
Organization Name:POTENTIAL LICENSED BEHAVIOR ANALYSTS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GOLDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARGARETEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSED, LBA, BCBA
Authorized Official - Phone:845-262-0422
Mailing Address - Street 1:8 BARBARA LN
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-2816
Mailing Address - Country:US
Mailing Address - Phone:845-426-6995
Mailing Address - Fax:888-506-2920
Practice Address - Street 1:8 BARBARA LN
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-2816
Practice Address - Country:US
Practice Address - Phone:845-426-6995
Practice Address - Fax:888-506-2920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty