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General NPI Number Information
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NPI Number | 1770025579
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Entity Type | Individual
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Provider Name | JAIR YEPEZ TORRES BCBA, LBA
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Gender | Male
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Dates
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Enumeration Date | 11/09/2016
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Last Update Date | 02/01/2022
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Provider Practice Location Address
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Address Line | 22107 100TH AVE
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City | QUEENS VILLAGE
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State | NY
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Zip | 11429-1631
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Country | US
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Telephone | 516-451-5420
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Fax |
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Provider Business Mailing Address
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Address Line | 148 GREENWICH ST APT 304
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City | HEMPSTEAD
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State | NY
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Zip | 11550-5673
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Country | US
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Telephone | 516-451-5420
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 001808-01
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License Number State | NY
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