Provider Demographics
NPI:1336619600
Name:NYLI LICENSED BEHAVIORANALYST PC
Entity Type:Organization
Organization Name:NYLI LICENSED BEHAVIORANALYST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA, LBA
Authorized Official - Phone:718-576-8783
Mailing Address - Street 1:1047 WASHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1818
Mailing Address - Country:US
Mailing Address - Phone:718-576-8783
Mailing Address - Fax:
Practice Address - Street 1:1047 WASHINGTON DR
Practice Address - Street 2:
Practice Address - City:CENTERPORT
Practice Address - State:NY
Practice Address - Zip Code:11721-1818
Practice Address - Country:US
Practice Address - Phone:718-576-8783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health