Provider Demographics
NPI:1467740134
Name:LAFASAKIS, MICHAEL (PHD,MS ED,BCBA-D)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LAFASAKIS
Suffix:
Gender:M
Credentials:PHD,MS ED,BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 110TH ST STE 303
Mailing Address - Street 2:
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-1448
Mailing Address - Country:US
Mailing Address - Phone:718-569-5439
Mailing Address - Fax:718-569-5439
Practice Address - Street 1:1434 110TH ST STE 303
Practice Address - Street 2:
Practice Address - City:COLLEGE POINT
Practice Address - State:NY
Practice Address - Zip Code:11356-1448
Practice Address - Country:US
Practice Address - Phone:718-569-5439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-15
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-04-1887103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst