Healthcare Provider Details

I. General information

NPI: 1003515222
Provider Name (Legal Business Name): A FRIENDLY FACE LICENSED BEHAVIOR ANALYST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1887 RICHMOND AVE STE 5
STATEN ISLAND NY
10314-3923
US

IV. Provider business mailing address

1887 RICHMOND AVE STE 5
STATEN ISLAND NY
10314-3923
US

V. Phone/Fax

Practice location:
  • Phone: 718-698-1300
  • Fax: 917-667-8601
Mailing address:
  • Phone: 718-698-1300
  • Fax: 917-667-8601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. ANNA MARIE DORELIEN
Title or Position: CLINICAL DIRECTOR
Credential: MSED., BCBA, LBA
Phone: 718-698-1300