Healthcare Provider Details

I. General information

NPI: 1659918449
Provider Name (Legal Business Name): MARIE KRYSTEL BORRAS STANKOV BCBA, NYS-LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2019
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

466 MAIN ST # LL20
NEW ROCHELLE NY
10801-6431
US

IV. Provider business mailing address

6421 BOOTH ST APT 1G
REGO PARK NY
11374-3025
US

V. Phone/Fax

Practice location:
  • Phone: 800-679-3609
  • Fax:
Mailing address:
  • Phone: 347-580-0787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number002444
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: