Healthcare Provider Details

I. General information

NPI: 1265389522
Provider Name (Legal Business Name): GENTLE STEPS LICENSED BEHAVIOR ANALYSIS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 RALPH AVE STE A1
BROOKLYN NY
11234-5300
US

IV. Provider business mailing address

29 LAMARR AVE
MELVILLE NY
11747-1244
US

V. Phone/Fax

Practice location:
  • Phone: 347-232-9067
  • 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
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: TANISHA MCKENZIE
Title or Position: DIRECTOR
Credential:
Phone: 347-232-9067