Healthcare Provider Details

I. General information

NPI: 1912884370
Provider Name (Legal Business Name): MY LANE APPLIED BEHAVIOR ANALYSIS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 WISSEMAN RD
LAGRANGEVILLE NY
12540-6810
US

IV. Provider business mailing address

88 WISSEMAN RD
LAGRANGEVILLE NY
12540-6810
US

V. Phone/Fax

Practice location:
  • Phone: 917-530-3208
  • Fax:
Mailing address:
  • Phone: 917-530-3208
  • 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: KHALIA MUSA
Title or Position: OWNER
Credential: BCBA, LBA
Phone: 917-530-3208