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General NPI Number Information
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NPI Number | 1275499444
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Entity Type | Organization
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Legal Business Name | NEW YORK BEHAVIORAL GROUP LICENSED BEHAVIOR ANALYSTS PLLC
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Dates
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Enumeration Date | 12/31/2025
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 1178 BROADWAY 3RD FL #4440
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City | NEW YORK
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State | NY
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Zip | 10001-5404
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Country | US
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Telephone | 631-260-1182
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Fax |
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Provider Business Mailing Address
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Address Line | 1178 BROADWAY 3RD FL #4440
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City | NEW YORK
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State | NY
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Zip | 10001-5404
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Country | US
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Telephone | 631-260-1182
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Fax |
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Authorized Official
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Title or Position | CO-FOUNDER
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Name | KHADIJA PROWELL
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Credential | BCBA
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Telephone | 347-244-9763
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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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