Healthcare Provider Details

I. General information

NPI: 1699248591
Provider Name (Legal Business Name): CASSIDY BAKOWSKI BCBA, LBA-NY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 TAMARACK ST
LIVERPOOL NY
13088-5122
US

IV. Provider business mailing address

200 TAMARACK ST
LIVERPOOL NY
13088-5122
US

V. Phone/Fax

Practice location:
  • Phone: 808-364-6494
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number003203-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: