=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336873207
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIL KNOW-IT OWLS BEHAVIOR CONSULTANT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2022
-----------------------------------------------------
Last Update Date | 07/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25 W 132ND ST APT 4L
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10037-3220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-974-6957
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25 W 132ND ST APT 4L
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10037-3220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-974-6957
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | DR. DWANETI ARICQUA BROOKS
-----------------------------------------------------
Credential | BCBA/LBA
-----------------------------------------------------
Telephone | 347-974-6957
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------