Healthcare Provider Details

I. General information

NPI: 1063325041
Provider Name (Legal Business Name): ALIVE ABA THERAPY MO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3919 BEDFORD AVE
BROOKLYN NY
11229-2435
US

IV. Provider business mailing address

3919 BEDFORD AVE
BROOKLYN NY
11229-2435
US

V. Phone/Fax

Practice location:
  • Phone: 347-860-1156
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: FAY BREZEL
Title or Position: DIRECTOR
Credential:
Phone: 718-436-5260