Provider Demographics
NPI:1669142329
Name:LONG ISLAND APPLIED BEHAVIOR ANALYSTS PC
Entity type:Organization
Organization Name:LONG ISLAND APPLIED BEHAVIOR ANALYSTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:D
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:516-441-5255
Mailing Address - Street 1:1 BARSTOW RD STE P20
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3510
Mailing Address - Country:US
Mailing Address - Phone:516-441-5255
Mailing Address - Fax:516-570-2291
Practice Address - Street 1:1 BARSTOW RD STE P20
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3510
Practice Address - Country:US
Practice Address - Phone:516-441-5255
Practice Address - Fax:516-570-2291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty