Healthcare Provider Details

I. General information

NPI: 1063163863
Provider Name (Legal Business Name): REBECCA'S ABA PLAY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
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: 718-503-2502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. REBECCA LEVY
Title or Position: PRINCIPAL
Credential: BCBA, LBA
Phone: 718-503-2502