MEDICARE: FARRAH NADIA HENRY

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
2	174400000X	Specialist

General Provider Information

NPI Number	:	1952039851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARRAH NADIA HENRY

Provider Business Mailing Address
First Line	:	4820 AVENUE L
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3106
Country	:	US
Telephone Number	:	917-932-3544
Fax Number	:

Provider Business Practice Location Address
First Line	:	4820 AVENUE L
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3106
Country	:	US
Telephone Number	:	917-932-3544
Fax Number	:

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

Provider Enumeration Date	:	08/10/2022
Last Update Date	:	01/25/2023

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Directions to “ FARRAH NADIA HENRY ” Practice Location

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