Provider Demographics
NPI:1275379687
Name:SPARKLE LICENSED BEHAVIOR ANALYST PC
Entity type:Organization
Organization Name:SPARKLE LICENSED BEHAVIOR ANALYST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MORDECHAI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-650-7894
Mailing Address - Street 1:51 FOREST RD STE 316-002
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-2948
Mailing Address - Country:US
Mailing Address - Phone:845-251-0070
Mailing Address - Fax:
Practice Address - Street 1:3 AUSTRA PKWY UNIT 4
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-6857
Practice Address - Country:US
Practice Address - Phone:845-251-0070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty