Healthcare Provider Details

I. General information

NPI: 1841061710
Provider Name (Legal Business Name): MJ BEHAVIORS LISENCED BEHAVIOR ANALYST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 FROEHLICH PL
ELMONT NY
11003-2907
US

IV. Provider business mailing address

518 FROEHLICH PL
ELMONT NY
11003-2907
US

V. Phone/Fax

Practice location:
  • Phone: 516-851-6213
  • Fax:
Mailing address:
  • Phone: 516-851-6213
  • 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 Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. MARTINE JANNINI
Title or Position: BCBA
Credential: LBA
Phone: 516-851-6217