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General NPI Number Information
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NPI Number | 1730682139
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Entity Type | Organization
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Legal Business Name | SPECTRUM ABA SERVICES OF NY
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Dates
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Enumeration Date | 03/12/2018
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Last Update Date | 03/12/2018
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Provider Practice Location Address
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Address Line | 21 SWEET HOLLOW RD
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City | HUNTINGTON
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State | NY
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Zip | 11743-6530
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Country | US
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Telephone | 631-385-3342
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Fax |
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Provider Business Mailing Address
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Address Line | 21 SWEET HOLLOW RD
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City | HUNTINGTON
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State | NY
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Zip | 11743-6530
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Country | US
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Telephone | 631-385-3342
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Fax |
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Authorized Official
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Title or Position | SUPERINTENDENT
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Name | DIANA DEVIVIO
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Credential | MD, PD
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Telephone | 631-760-7959
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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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