Provider Demographics
NPI:1407410319
Name:BRIANA RISPOLI LLC
Entity Type:Organization
Organization Name:BRIANA RISPOLI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ABA THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIANA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:RISPOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:718-744-7458
Mailing Address - Street 1:70 MYRNA LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-1626
Mailing Address - Country:US
Mailing Address - Phone:718-744-7458
Mailing Address - Fax:
Practice Address - Street 1:70 MYRNA LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-1626
Practice Address - Country:US
Practice Address - Phone:718-744-7458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency