Healthcare Provider Details

I. General information

NPI: 1093624694
Provider Name (Legal Business Name): RIVKA AVIVA GRUEN MS, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AVIVA GREENBAUM MS, BCBA

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1568 E 31ST ST
BROOKLYN NY
11234-3402
US

IV. Provider business mailing address

1568 E 31ST ST
BROOKLYN NY
11234-3402
US

V. Phone/Fax

Practice location:
  • Phone: 718-986-7553
  • Fax:
Mailing address:
  • Phone: 718-986-7553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1262832060
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: