Healthcare Provider Details

I. General information

NPI: 1043156300
Provider Name (Legal Business Name): RIVKY TYBERG BCBA, LBA, MSED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1927 52ND ST
BROOKLYN NY
11204-1732
US

IV. Provider business mailing address

1927 52ND ST
BROOKLYN NY
11204-1732
US

V. Phone/Fax

Practice location:
  • Phone: 347-491-9992
  • Fax:
Mailing address:
  • Phone: 347-491-9992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number004970-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: