Healthcare Provider Details

I. General information

NPI: 1538855796
Provider Name (Legal Business Name): BRIAN GOLDMAN LICENSED BEHAVIORAL ANALYSIS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 LEE AVE
EAST WILLISTON NY
11596-2424
US

IV. Provider business mailing address

35 LEE AVE
EAST WILLISTON NY
11596-2424
US

V. Phone/Fax

Practice location:
  • Phone: 516-376-2055
  • Fax: 800-874-0959
Mailing address:
  • Phone: 516-376-2055
  • Fax: 800-874-0959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN GOLDMAN
Title or Position: OWNER
Credential: BCBA, LBA
Phone: 516-376-2055