Provider Demographics
NPI:1720672249
Name:LIGHTHOUSE LICENSED BEHAVIOR ANALYSTS PLLC
Entity Type:Organization
Organization Name:LIGHTHOUSE LICENSED BEHAVIOR ANALYSTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:HURWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA LBA
Authorized Official - Phone:347-277-2575
Mailing Address - Street 1:13636 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2328
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13636 72ND AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2328
Practice Address - Country:US
Practice Address - Phone:347-277-2575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty