Healthcare Provider Details

I. General information

NPI: 1497486294
Provider Name (Legal Business Name): MVD APPLIED BEHAVIOR ANALYST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 GARTH RD APT 5E
SCARSDALE NY
10583-8004
US

IV. Provider business mailing address

209 GARTH RD APT 5E
SCARSDALE NY
10583-8004
US

V. Phone/Fax

Practice location:
  • Phone: 845-807-7031
  • Fax:
Mailing address:
  • Phone: 845-807-7031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARISA DECHIARO
Title or Position: OWNER
Credential: LBA-NYS
Phone: 845-807-7031