Provider Demographics
NPI:1689949869
Name:BARNETT, ELLEN BETH (MA, BCBA, LBA)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:BETH
Last Name:BARNETT
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 MAIN ST
Mailing Address - Street 2:1607
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10044-0129
Mailing Address - Country:US
Mailing Address - Phone:212-308-9789
Mailing Address - Fax:
Practice Address - Street 1:555 MAIN ST APT 1607
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10044-0337
Practice Address - Country:US
Practice Address - Phone:917-539-2961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000246103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty