Provider Demographics
NPI:1871205765
Name:MORDKOVITCH, LINDA (LBA, BCBA)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:MORDKOVITCH
Suffix:
Gender:F
Credentials:LBA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 ARDMORE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4348
Mailing Address - Country:US
Mailing Address - Phone:917-853-3366
Mailing Address - Fax:
Practice Address - Street 1:105 SCHUNNEMUNK RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-6256
Practice Address - Country:US
Practice Address - Phone:845-477-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NY001734-01103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst