=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326271974
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHILDREN FIRST SPEECH LANGUAGE PATHOLOGY AND PSYCHOLOGY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2009
-----------------------------------------------------
Last Update Date | 09/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 CONKLIN AVENUE
-----------------------------------------------------
City | TAPPAN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10983
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-746-2609
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 CONKLIN AVE
-----------------------------------------------------
City | TAPPAN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10983-2005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-746-2609
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF ABA SERVICES
-----------------------------------------------------
Name | SARA MELANIE KAHN
-----------------------------------------------------
Credential | M.A., BCBA
-----------------------------------------------------
Telephone | 845-848-2585
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 015985-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 011945
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 1020796
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------