Provider Demographics
NPI:1003515222
Name:A FRIENDLY FACE LICENSED BEHAVIOR ANALYST
Entity Type:Organization
Organization Name:A FRIENDLY FACE LICENSED BEHAVIOR ANALYST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DORELIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSED, BCBA, LBA
Authorized Official - Phone:718-698-1300
Mailing Address - Street 1:1887 RICHMOND AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3923
Mailing Address - Country:US
Mailing Address - Phone:718-698-1300
Mailing Address - Fax:917-667-8601
Practice Address - Street 1:1887 RICHMOND AVE STE 5
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3923
Practice Address - Country:US
Practice Address - Phone:718-698-1300
Practice Address - Fax:917-667-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty