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General NPI Number Information
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NPI Number | 1326776378
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Entity Type | Organization
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Legal Business Name | SPROUT LICENSED BEHAVIOR ANALYST PLLC
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Dates
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Enumeration Date | 08/09/2022
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 225 W 83RD ST APT 6Z
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City | NEW YORK
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State | NY
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Zip | 10024-4955
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Country | US
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Telephone | 201-873-1548
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Fax |
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Provider Business Mailing Address
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Address Line | 433 FOREST AVE
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City | TEANECK
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State | NJ
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Zip | 07666-2773
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Country | US
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Telephone | 201-873-1548
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ADINA MILGRAM
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Credential | BCBA
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Telephone | 201-873-1548
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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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