MEDICARE: MR. GEOFFREY DEBERY BCBA

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1326371741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEOFFREY DEBERY BCBA

Provider Business Mailing Address
First Line	:	443 17TH ST
Second Line	:	APT 1L
City	:	BROOKLYN
State	:	NY
Zip	:	11215-6233
Country	:	US
Telephone Number	:	215-495-2411
Fax Number	:

Provider Business Practice Location Address
First Line	:	443 17TH ST
Second Line	:	APT 1L
City	:	BROOKLYN
State	:	NY
Zip	:	11215-6233
Country	:	US
Telephone Number	:	215-495-2411
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2009
Last Update Date	:	09/16/2009

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