Healthcare Provider Details

I. General information

NPI: 1780451732
Provider Name (Legal Business Name): PROGRESSIVE APPLIED BEHAVIOR ANALYSIS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 LENMORE DR
OLD BETHPAGE NY
11804-1119
US

IV. Provider business mailing address

2698 RIVERSIDE AVE
MERRICK NY
11566-4515
US

V. Phone/Fax

Practice location:
  • Phone: 917-496-6144
  • Fax:
Mailing address:
  • Phone: 917-496-6144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CYNTHIA E MARTINEZ
Title or Position: OWNER
Credential: BCBA, LBA
Phone: 917-496-6144