Provider Demographics
NPI:1750894572
Name:CARES LICENSED BEHAVIOR ANALYST PC
Entity type:Organization
Organization Name:CARES LICENSED BEHAVIOR ANALYST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHERIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:YITZCHOK
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAKAUER
Authorized Official - Suffix:
Authorized Official - Credentials:LBA
Authorized Official - Phone:347-770-4382
Mailing Address - Street 1:1305 53RD ST STE 141
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-3840
Mailing Address - Country:US
Mailing Address - Phone:718-673-6446
Mailing Address - Fax:718-387-6429
Practice Address - Street 1:1305 53RD ST STE 141
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3840
Practice Address - Country:US
Practice Address - Phone:718-419-6543
Practice Address - Fax:718-387-6429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000427103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty