Provider Demographics
NPI:1326776378
Name:SPROUT LICENSED BEHAVIOR ANALYST PLLC
Entity Type:Organization
Organization Name:SPROUT LICENSED BEHAVIOR ANALYST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:201-873-1548
Mailing Address - Street 1:433 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2773
Mailing Address - Country:US
Mailing Address - Phone:201-873-1548
Mailing Address - Fax:
Practice Address - Street 1:225 W 83RD ST APT 6Z
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-4955
Practice Address - Country:US
Practice Address - Phone:201-873-1548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty