Healthcare Provider Details

I. General information

NPI: 1265948376
Provider Name (Legal Business Name): ANNA ZELENSKIY BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2017
Last Update Date: 04/06/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87-2243 PAKEKE ST
WAIANAE HI
96792-5403
US

IV. Provider business mailing address

87-2243 PAKEKE ST
WAIANAE HI
96792-5403
US

V. Phone/Fax

Practice location:
  • Phone: 917-302-0293
  • Fax: 808-480-7440
Mailing address:
  • Phone: 917-302-0293
  • Fax: 808-480-7440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: