MEDICARE: BRIGHT BEGINNINGS LICENSED BEHAVIOR ANALYST

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	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1124584362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT BEGINNINGS LICENSED BEHAVIOR ANALYST

Provider Business Mailing Address
First Line	:	672 DOGWOOD AVE STE 197
Second Line	:
City	:	FRANKLIN SQUARE
State	:	NY
Zip	:	11010-3247
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	672 DOGWOOD AVE STE 197
Second Line	:
City	:	FRANKLIN SQUARE
State	:	NY
Zip	:	11010-3247
Country	:	US
Telephone Number	:	516-564-3539
Fax Number	:

Authorized Official
Title or Position	:	LICENSED BEHAVIOR ANALYST
Name	:	MS. TZIPI HANINA
Credential	:
Telephone Number	:	516-564-3539

Provider Enumeration Date	:	02/12/2019
Last Update Date	:	02/12/2019

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