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General NPI Number Information
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NPI Number | 1275379687
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Entity Type | Organization
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Legal Business Name | SPARKLE LICENSED BEHAVIOR ANALYST PC
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Dates
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Enumeration Date | 07/04/2024
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 3 AUSTRA PKWY UNIT 4
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City | MONROE
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State | NY
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Zip | 10950-6857
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Country | US
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Telephone | 845-251-0070
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Fax |
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Provider Business Mailing Address
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Address Line | 51 FOREST RD STE 316-002
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City | MONROE
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State | NY
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Zip | 10950-2948
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Country | US
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Telephone | 845-251-0070
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MORDECHAI LEIFER
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Credential |
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Telephone | 718-650-7894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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