Provider Demographics
NPI:1720657828
Name:MITZMANN, TZVI HIRSCH (BCBA)
Entity Type:Individual
Prefix:MR
First Name:TZVI
Middle Name:HIRSCH
Last Name:MITZMANN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1056 NEILSON ST APT 2B
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5033
Mailing Address - Country:US
Mailing Address - Phone:845-271-9663
Mailing Address - Fax:
Practice Address - Street 1:333 PEARSALL AVE STE 100
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-1842
Practice Address - Country:US
Practice Address - Phone:516-213-3338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP110030103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst