Healthcare Provider Details

I. General information

NPI: 1861349524
Provider Name (Legal Business Name): BRANDON ALI THOMAS M.S., BCBA, LBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 E 16TH ST APT 5C
BROOKLYN NY
11235-4018
US

IV. Provider business mailing address

2775 E 16TH ST APT 5C
BROOKLYN NY
11235-4018
US

V. Phone/Fax

Practice location:
  • Phone: 347-605-3392
  • Fax:
Mailing address:
  • Phone: 347-605-3392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-88107
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: