Provider Demographics
NPI:1710757638
Name:SUNRISE LICENSED BEHAVIORAL ANALYST
Entity Type:Organization
Organization Name:SUNRISE LICENSED BEHAVIORAL ANALYST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEVORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MS ED, BCBA LBA
Authorized Official - Phone:917-890-4383
Mailing Address - Street 1:204 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-7595
Mailing Address - Country:US
Mailing Address - Phone:917-890-4383
Mailing Address - Fax:
Practice Address - Street 1:204 WILSON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-7595
Practice Address - Country:US
Practice Address - Phone:917-890-4383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty