Provider Demographics
NPI:1689332165
Name:PEER LICENSED BEHAVIOR ANALYST, PLLC
Entity Type:Organization
Organization Name:PEER LICENSED BEHAVIOR ANALYST, PLLC
Other - Org Name:ESCALATE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LBA
Authorized Official - Phone:347-489-8817
Mailing Address - Street 1:24 WITZEL CT UNIT 206
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-7823
Mailing Address - Country:US
Mailing Address - Phone:347-489-8817
Mailing Address - Fax:718-387-6429
Practice Address - Street 1:24 WITZEL CT UNIT 206
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-7823
Practice Address - Country:US
Practice Address - Phone:347-489-8817
Practice Address - Fax:718-387-6429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty