Healthcare Provider Details

I. General information

NPI: 1558116244
Provider Name (Legal Business Name): SIMPLY INNOVATIVE BEHAVIOR ANALYSIS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 NEW MILL RD
SMITHTOWN NY
11787-3324
US

IV. Provider business mailing address

PO BOX 236
SMITHTOWN NY
11787-0236
US

V. Phone/Fax

Practice location:
  • Phone: 631-352-2651
  • Fax:
Mailing address:
  • Phone: 631-352-2651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MASSARO
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MS.ED LBA BCBA
Phone: 631-741-4790