Provider Demographics
NPI:1073865002
Name:LASS, TOBEY SARAH (MED, BCBA, LBA)
Entity Type:Individual
Prefix:MS
First Name:TOBEY
Middle Name:SARAH
Last Name:LASS
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 JOHNSON AVE APT 2E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1632
Mailing Address - Country:US
Mailing Address - Phone:732-754-7061
Mailing Address - Fax:
Practice Address - Street 1:20 ROBERT PITT DR STE 212
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-3340
Practice Address - Country:US
Practice Address - Phone:845-425-2299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NY668063121174400000X
NY000109103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist