Provider Demographics
NPI:1710680160
Name:SCHULTZ, BRYNNE MARTA (BCBA)
Entity Type:Individual
Prefix:
First Name:BRYNNE
Middle Name:MARTA
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 32ND ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2301
Mailing Address - Country:US
Mailing Address - Phone:920-815-8946
Mailing Address - Fax:
Practice Address - Street 1:2125 32ND ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2301
Practice Address - Country:US
Practice Address - Phone:920-815-8946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-21-48847103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst