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General NPI Number Information
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NPI Number | 1346900925
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Entity Type | Organization
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Legal Business Name | BOLD ARROW LICENSED BEHAVIOR ANALYST PC
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Dates
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Enumeration Date | 12/23/2021
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Last Update Date | 12/23/2021
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Provider Practice Location Address
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Address Line | 6 LAURA DR
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City | AIRMONT
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State | NY
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Zip | 10952-3402
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Country | US
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Telephone | 718-222-5999
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Fax | 718-387-6429
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Provider Business Mailing Address
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Address Line | 6 LAURA DR
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City | AIRMONT
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State | NY
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Zip | 10952-3402
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Country | US
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Telephone | 718-222-5999
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Fax | 718-387-6429
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Authorized Official
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Title or Position | CEO
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Name | YITZCHAK LUBART
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Credential | BCBA
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Telephone | 718-222-5999
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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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