Provider Demographics
NPI:1871277442
Name:NEW YORK LBA BEHAVIORAL CONSULTING LLC
Entity type:Organization
Organization Name:NEW YORK LBA BEHAVIORAL CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAC DONALD
Authorized Official - Suffix:
Authorized Official - Credentials:NYS LBA
Authorized Official - Phone:631-312-0523
Mailing Address - Street 1:15 NEWMAN ST
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1118
Mailing Address - Country:US
Mailing Address - Phone:631-312-0523
Mailing Address - Fax:
Practice Address - Street 1:15 NEWMAN ST
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1118
Practice Address - Country:US
Practice Address - Phone:631-312-0523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty