Healthcare Provider Details

I. General information

NPI: 1275445694
Provider Name (Legal Business Name): LITTLE TEDDY BEARS APPLIED BEHAVIOR ANALYSIS SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 149TH ST FL 2
WHITESTONE NY
11357-2529
US

IV. Provider business mailing address

1715 149TH ST FL 2
WHITESTONE NY
11357-2529
US

V. Phone/Fax

Practice location:
  • Phone: 347-400-0347
  • Fax:
Mailing address:
  • Phone: 347-400-0347
  • 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: MISS SUNGHEE KIM
Title or Position: BCBA
Credential: BCBA,LBA
Phone: 347-400-0347