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General NPI Number Information
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NPI Number | 1629223987
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Entity Type | Organization
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Legal Business Name | ANDRETTA BEHAVIOR ANALYSTS, INC.
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Dates
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Enumeration Date | 11/28/2008
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Last Update Date | 11/28/2008
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Provider Practice Location Address
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Address Line | 14 RASSMUSSEN PL
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City | MELVILLE
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State | NY
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Zip | 11747-1528
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Country | US
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Telephone | 631-961-1405
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Fax | 631-673-1222
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Provider Business Mailing Address
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Address Line | 14 RASSMUSSEN PL
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City | MELVILLE
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State | NY
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Zip | 11747-1528
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Country | US
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Telephone | 631-961-1405
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Fax | 631-673-1222
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. MELISSA JO ANDRETTA
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Credential | BCBA, MS
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Telephone | 631-961-1405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 099685556
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1031217
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License Number State | NY
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