Provider Demographics
NPI:1821307406
Name:BEHAVIOR CHANGE SUCCESS CORP
Entity Type:Organization
Organization Name:BEHAVIOR CHANGE SUCCESS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MS BCBA
Authorized Official - Phone:516-799-1045
Mailing Address - Street 1:331 EASTLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-1836
Mailing Address - Country:US
Mailing Address - Phone:516-640-0798
Mailing Address - Fax:
Practice Address - Street 1:331 EASTLAKE AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-1836
Practice Address - Country:US
Practice Address - Phone:516-640-0798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1095079251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health