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General NPI Number Information
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NPI Number | 1417483231
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Entity Type | Organization
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Legal Business Name | MAC BEHAVIOR SOLUTIONS
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 17 ADAMS ST
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City | EAST ROCKAWAY
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State | NY
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Zip | 11518-1705
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Country | US
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Telephone | 516-236-7475
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Fax |
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Provider Business Mailing Address
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Address Line | 17 ADAMS ST
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City | EAST ROCKAWAY
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State | NY
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Zip | 11518-1705
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Country | US
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Telephone | 516-236-7475
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MR. WILLIAM THOMAS MCCABE JR.
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Credential | MSED, BCBA, LBA
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Telephone | 516-236-7475
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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 | 001120
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License Number State | NY
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