Provider Demographics
NPI:1497012439
Name:BEIRNE, ANN (MA,BCBA)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:BEIRNE
Suffix:
Gender:F
Credentials:MA,BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4526 44TH ST
Mailing Address - Street 2:APT 3C
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-2420
Mailing Address - Country:US
Mailing Address - Phone:347-517-2477
Mailing Address - Fax:
Practice Address - Street 1:4526 44TH ST
Practice Address - Street 2:APT 3C
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-2420
Practice Address - Country:US
Practice Address - Phone:347-517-2477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-08-4259OtherBACB CERTIFICANT NUMBER