Healthcare Provider Details

I. General information

NPI: 1720979628
Provider Name (Legal Business Name): EMPOWER KIDS LICENSED BEHAVIOR ANALYSTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 CHESTNUT RIDGE RD
SPRING VALLEY NY
10977-6608
US

IV. Provider business mailing address

940 CHESTNUT RIDGE RD
SPRING VALLEY NY
10977-6608
US

V. Phone/Fax

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

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: ETTY BRACH
Title or Position: OWNER
Credential: BCBA, LBA
Phone: 347-534-7728