MEDICARE: SIMPLY INNOVATIVE BEHAVIOR ANALYSIS PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	103K00000X	Behavior Analyst
3	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1558116244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPLY INNOVATIVE BEHAVIOR ANALYSIS PLLC

Provider Business Mailing Address
First Line	:	PO BOX 236
Second Line	:
City	:	SMITHTOWN
State	:	NY
Zip	:	11787-0236
Country	:	US
Telephone Number	:	631-352-2651
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 NEW MILL RD
Second Line	:
City	:	SMITHTOWN
State	:	NY
Zip	:	11787-3324
Country	:	US
Telephone Number	:	631-352-2651
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	JENNIFER MASSARO
Credential	:	MS.ED LBA BCBA
Telephone Number	:	631-741-4790

Provider Enumeration Date	:	04/17/2024
Last Update Date	:	09/08/2025

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