MEDICARE: GABRIELLA DAVILA MA, BCBA, LBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	002069	NY

General Provider Information

NPI Number	:	1083211825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLA DAVILA MA, BCBA, LBA

Provider Business Mailing Address
First Line	:	3417 30TH ST APT 5A
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-3036
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3417 30TH ST APT 5A
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-3036
Country	:	US
Telephone Number	:	845-521-2145
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2020
Last Update Date	:	10/11/2023

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