Provider Demographics
NPI:1700137320
Name:GARCIA, ILANA (BCBA)
Entity Type:Individual
Prefix:
First Name:ILANA
Middle Name:
Last Name:GARCIA
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:PO BOX 900
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-0900
Mailing Address - Country:US
Mailing Address - Phone:845-765-0463
Mailing Address - Fax:516-706-1418
Practice Address - Street 1:24 TAMARACK LN
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-2011
Practice Address - Country:US
Practice Address - Phone:845-765-0463
Practice Address - Fax:516-706-1418
Is Sole Proprietor?:No
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11211552103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst