Provider Demographics
NPI:1821667890
Name:CREATIVE BEHAVIOR SERVICES LICENSED BEHAVIOR ANALYST PLLC
Entity Type:Organization
Organization Name:CREATIVE BEHAVIOR SERVICES LICENSED BEHAVIOR ANALYST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEMETRIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:FINCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-938-1256
Mailing Address - Street 1:108-14 72ND AVENUE
Mailing Address - Street 2:2ND FL
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:108-14 72ND AVENUE
Practice Address - Street 2:2ND FL
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-938-1256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty