Provider Demographics
NPI:1326452368
Name:DISCALFANI, JUSTIN (PHD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:DISCALFANI
Suffix:
Gender:M
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 1:4 WINDMILL CT
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2224
Mailing Address - Country:US
Mailing Address - Phone:631-793-7127
Mailing Address - Fax:
Practice Address - Street 1:206 E MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3598
Practice Address - Country:US
Practice Address - Phone:631-793-7127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020656103TC0700X
NY000010103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst