Provider Demographics
NPI:1679877914
Name:NOVOGRODSKY, DOROTHY (ED D BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:
Last Name:NOVOGRODSKY
Suffix:
Gender:F
Credentials:ED D 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:PO BOX 153
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12789-0153
Mailing Address - Country:US
Mailing Address - Phone:845-798-6502
Mailing Address - Fax:845-434-1077
Practice Address - Street 1:223 DAIRYLAND RD.
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:NY
Practice Address - Zip Code:12789-0153
Practice Address - Country:US
Practice Address - Phone:845-798-6502
Practice Address - Fax:845-434-1077
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-30
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-08-4711103K00000X
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-08-4711OtherBCBA-D