Provider Demographics
NPI:1760995518
Name:ACHIEVE BEYOND LICENSED BEHAVIOR ANALYST SERVICES PC
Entity Type:Organization
Organization Name:ACHIEVE BEYOND LICENSED BEHAVIOR ANALYST SERVICES PC
Other - Org Name:ACHIEVE BEYOND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-385-7780
Mailing Address - Street 1:225 BROADHOLLOW RD STE 402
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4822
Mailing Address - Country:US
Mailing Address - Phone:631-385-7780
Mailing Address - Fax:631-385-7795
Practice Address - Street 1:225 BROADHOLLOW RD STE 402
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4822
Practice Address - Country:US
Practice Address - Phone:631-385-7780
Practice Address - Fax:631-385-7795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty