MEDICARE: CROSS RIVER THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1003433491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSS RIVER THERAPY

Provider Business Mailing Address
First Line	:	740 CEDAR LAWN AVE
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-5304
Country	:	US
Telephone Number	:	646-577-8787
Fax Number	:

Provider Business Practice Location Address
First Line	:	3455 PEACHTREE RD NE FL 5
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-3254
Country	:	US
Telephone Number	:	646-577-8787
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	STEVEN ZAUDERER
Credential	:
Telephone Number	:	646-499-1825

Provider Enumeration Date	:	07/01/2020
Last Update Date	:	11/29/2021

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