Provider Demographics
NPI:1275920191
Name:LICENSED APPLIED BEHAVIOR ANALYSIS OF NY P.C.
Entity Type:Organization
Organization Name:LICENSED APPLIED BEHAVIOR ANALYSIS OF NY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIANN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAI
Authorized Official - Suffix:
Authorized Official - Credentials:MSED, SAS, BCBA
Authorized Official - Phone:516-778-8871
Mailing Address - Street 1:2417 JERICHO TURNPIKE #124
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11410
Mailing Address - Country:US
Mailing Address - Phone:516-778-8871
Mailing Address - Fax:
Practice Address - Street 1:2417 JERICHO TPKE # 124
Practice Address - Street 2:
Practice Address - City:GARDEN CITY PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4710
Practice Address - Country:US
Practice Address - Phone:516-778-8871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000094103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty