Provider Demographics
NPI:1659918449
Name:STANKOV, MARIE KRYSTEL BORRAS (BCBA, NYS-LBA)
Entity Type:Individual
Prefix:
First Name:MARIE KRYSTEL
Middle Name:BORRAS
Last Name:STANKOV
Suffix:
Gender:F
Credentials:BCBA, NYS-LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6421 BOOTH ST APT 1G
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3025
Mailing Address - Country:US
Mailing Address - Phone:347-580-0787
Mailing Address - Fax:
Practice Address - Street 1:466 MAIN ST # LL20
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-6431
Practice Address - Country:US
Practice Address - Phone:800-679-3609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-29
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NY002444103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty