Provider Demographics
NPI:1922369727
Name:BROKAW-SHAPIRO, ASHLEY (MS, ED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BROKAW-SHAPIRO
Suffix:
Gender:F
Credentials:MS, ED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10706-1105
Mailing Address - Country:US
Mailing Address - Phone:516-770-2060
Mailing Address - Fax:
Practice Address - Street 1:55 CALUMET AVE APT 2
Practice Address - Street 2:
Practice Address - City:HASTINGS ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10706-1105
Practice Address - Country:US
Practice Address - Phone:516-770-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000402103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst