Provider Demographics
NPI:1518459395
Name:BRACE, DAWN ARETHA (MS, BCBA, LBA-NY)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:ARETHA
Last Name:BRACE
Suffix:
Gender:F
Credentials:MS, BCBA, LBA-NY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 NETHERLAND AVE APT 6E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3455
Mailing Address - Country:US
Mailing Address - Phone:917-371-8357
Mailing Address - Fax:
Practice Address - Street 1:3220 NETHERLAND AVE APT 6E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3455
Practice Address - Country:US
Practice Address - Phone:917-371-8357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001545103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst