MEDICARE: DISCOVER LICENSED BEHAVIOR ANALYST 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	174400000X	Specialist

General Provider Information

NPI Number	:	1801402060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISCOVER LICENSED BEHAVIOR ANALYST PLLC

Provider Business Mailing Address
First Line	:	1350 55TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-4213
Country	:	US
Telephone Number	:	347-271-0792
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 55TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-4213
Country	:	US
Telephone Number	:	134-727-1079
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DAVID LEBOWITZ
Credential	:
Telephone Number	:	134-727-1079

Provider Enumeration Date	:	09/22/2020
Last Update Date	:	09/22/2020

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