Provider Demographics
NPI:1982056016
Name:GERLEIT, KRISTA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:GERLEIT
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7117 10TH AVE
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-1230
Mailing Address - Country:US
Mailing Address - Phone:415-310-7434
Mailing Address - Fax:
Practice Address - Street 1:7117 10TH AVE
Practice Address - Street 2:FLOOR 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-1230
Practice Address - Country:US
Practice Address - Phone:415-310-7434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000734-1103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst