Provider Demographics
NPI:1306214499
Name:PANTELIDES, MARIA (BCBA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:PANTELIDES
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 CHESTNUT RIDGE RD STE 206
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10977-5669
Mailing Address - Country:US
Mailing Address - Phone:718-650-6540
Mailing Address - Fax:718-650-6475
Practice Address - Street 1:501 CHESTNUT RIDGE RD STE 206
Practice Address - Street 2:
Practice Address - City:CHESTNUT RIDGE
Practice Address - State:NY
Practice Address - Zip Code:10977-5669
Practice Address - Country:US
Practice Address - Phone:718-650-6540
Practice Address - Fax:718-650-6475
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11211760103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11211760OtherBEHAVIOR ANALYST CERTIFICATION BOARD