Healthcare Provider Details

I. General information

NPI: 1316401391
Provider Name (Legal Business Name): EMPOWER KIDS LICENSED APPLIED BEHAVIORAL ANALYST PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 RED SCHOOLHOUSE RD STE 107
SPRING VALLEY NY
10977-7052
US

IV. Provider business mailing address

80 RED SCHOOLHOUSE RD STE 107
SPRING VALLEY NY
10977-7052
US

V. Phone/Fax

Practice location:
  • Phone: 845-218-8069
  • Fax: 845-364-6332
Mailing address:
  • Phone: 845-218-8069
  • Fax: 845-364-6332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: GITTY BRACH
Title or Position: CFO
Credential:
Phone: 845-218-8069