Provider Demographics
NPI:1518229822
Name:KRSTOVSKA-GUERRERO, IVANA (BCBA)
Entity Type:Individual
Prefix:
First Name:IVANA
Middle Name:
Last Name:KRSTOVSKA-GUERRERO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:IVANA
Other - Middle Name:
Other - Last Name:KRSTOVSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:99 HILLSIDE AVENUE
Mailing Address - Street 2:APT 19 C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-2723
Mailing Address - Country:US
Mailing Address - Phone:917-957-8159
Mailing Address - Fax:
Practice Address - Street 1:99 HILLSIDE AVENUE
Practice Address - Street 2:APT 19 C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-2723
Practice Address - Country:US
Practice Address - Phone:917-957-8159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021188103TB0200X, 103T00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No174400000XOther Service ProvidersSpecialist