Provider Demographics
NPI:1699364687
Name:ASRA, SUMAN MOHAMMAD (MA, LBA, BCBA)
Entity Type:Individual
Prefix:
First Name:SUMAN
Middle Name:MOHAMMAD
Last Name:ASRA
Suffix:
Gender:F
Credentials:MA, LBA, BCBA
Other - Prefix:
Other - First Name:SUMAN
Other - Middle Name:
Other - Last Name:MOHAMMAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LBA, BCBA
Mailing Address - Street 1:205 LIDO PKWY
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-6022
Mailing Address - Country:US
Mailing Address - Phone:718-310-7452
Mailing Address - Fax:
Practice Address - Street 1:6214 24TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3319
Practice Address - Country:US
Practice Address - Phone:718-633-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002057103K00000X
NY1-20-44049103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst