Provider Demographics
NPI:1194038760
Name:OSTRYN, CHERYL (PHD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:
Last Name:OSTRYN
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SOUTHSIDE DR STE 11
Mailing Address - Street 2:#125
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3870
Mailing Address - Country:US
Mailing Address - Phone:720-346-1626
Mailing Address - Fax:
Practice Address - Street 1:5 SOUTHSIDE DR STE 11
Practice Address - Street 2:#125
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3870
Practice Address - Country:US
Practice Address - Phone:720-346-1626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-10-7198103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst