Healthcare Provider Details

I. General information

NPI: 1811653694
Provider Name (Legal Business Name): NEW LIFE BEHAVIOR SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18917 SUFFOLK DR
SAINT ALBANS NY
11412-3010
US

IV. Provider business mailing address

18917 SUFFOLK DR
SAINT ALBANS NY
11412-3010
US

V. Phone/Fax

Practice location:
  • Phone: 718-710-8280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ASHONDA WARNER
Title or Position: BEHAVIOR ANALYST
Credential: BCBA LBA
Phone: 718-710-8280