Provider Demographics
NPI:1003266800
Name:RESNICK, ALYSSA (MA, BCBA, LBA-NY)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:RESNICK
Suffix:
Gender:F
Credentials:MA, BCBA, LBA-NY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 PARK AVE APT 11E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3485
Mailing Address - Country:US
Mailing Address - Phone:516-880-4003
Mailing Address - Fax:
Practice Address - Street 1:41 PARK AVE APT 11E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3485
Practice Address - Country:US
Practice Address - Phone:516-880-4003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1039892161174400000X
NY1037676161174400000X
NY1-16-23964103K00000X
NY1039893161174400000X
NY1037678161174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist