Healthcare Provider Details

I. General information

NPI: 1811793607
Provider Name (Legal Business Name): DS BEHAVIORAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 KINGSTON AVE FL 2
BROOKLYN NY
11225-3127
US

IV. Provider business mailing address

419 KINGSTON AVE FL 2
BROOKLYN NY
11225-3127
US

V. Phone/Fax

Practice location:
  • Phone: 347-770-4032
  • Fax: 718-691-6897
Mailing address:
  • Phone: 347-770-4032
  • Fax: 718-691-6897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL SEBBAG
Title or Position: PROVIDER
Credential: PSYD
Phone: 347-770-4032