Healthcare Provider Details

I. General information

NPI: 1619300068
Provider Name (Legal Business Name): REBECCA LEVY LBA, BCBA, MSED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA LEVY LBA, BCBA, MSED

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7547 181ST ST
FRESH MEADOWS NY
11366-1609
US

IV. Provider business mailing address

7547 181ST ST
FRESH MEADOWS NY
11366-1609
US

V. Phone/Fax

Practice location:
  • Phone: 718-503-2502
  • Fax:
Mailing address:
  • Phone: 718-969-3489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number002244
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number403571
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: