Provider Demographics
NPI:1316401391
Name:EMPOWER KIDS LICENSED APPLIED BEHAVIORAL ANALYST PLLC
Entity Type:Organization
Organization Name:EMPOWER KIDS LICENSED APPLIED BEHAVIORAL ANALYST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GITTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-218-8069
Mailing Address - Street 1:80 RED SCHOOLHOUSE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-7052
Mailing Address - Country:US
Mailing Address - Phone:845-218-8069
Mailing Address - Fax:845-364-6332
Practice Address - Street 1:80 RED SCHOOLHOUSE RD STE 107
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-7052
Practice Address - Country:US
Practice Address - Phone:845-218-8069
Practice Address - Fax:845-364-6332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty