Provider Demographics
NPI:1245534536
Name:WANG, CRISSY L (BCBA)
Entity type:Individual
Prefix:MRS
First Name:CRISSY
Middle Name:L
Last Name:WANG
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 PINE TREE LN
Mailing Address - Street 2:
Mailing Address - City:TAPPAN
Mailing Address - State:NY
Mailing Address - Zip Code:10983-2114
Mailing Address - Country:US
Mailing Address - Phone:845-641-8015
Mailing Address - Fax:
Practice Address - Street 1:3 SALISBURY PT
Practice Address - Street 2:APT 4E
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-4737
Practice Address - Country:US
Practice Address - Phone:845-641-8015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-01
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171W00000XOther Service ProvidersContractor