MEDICARE: GENTLE STEPS LICENSED BEHAVIOR ANALYSIS, PLLC

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	252Y00000X	Early Intervention Provider Agency
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1265389522
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTLE STEPS LICENSED BEHAVIOR ANALYSIS, PLLC

Provider Business Mailing Address
First Line	:	29 LAMARR AVE
Second Line	:
City	:	MELVILLE
State	:	NY
Zip	:	11747-1244
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2035 RALPH AVE STE A1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5300
Country	:	US
Telephone Number	:	347-232-9067
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	TANISHA MCKENZIE
Credential	:
Telephone Number	:	347-232-9067

Provider Enumeration Date	:	03/14/2026
Last Update Date	:	04/23/2026

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