Provider Demographics
NPI:1134994437
Name:LIVING SOUL OF NEW YORK APPLIED BEHAVIOR ANALYSIS, PLLC
Entity type:Organization
Organization Name:LIVING SOUL OF NEW YORK APPLIED BEHAVIOR ANALYSIS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:585-401-4363
Mailing Address - Street 1:75 S CLINTON AVE STE 510
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14604-1748
Mailing Address - Country:US
Mailing Address - Phone:585-401-4363
Mailing Address - Fax:
Practice Address - Street 1:75 S CLINTON AVE STE 510
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14604-1748
Practice Address - Country:US
Practice Address - Phone:585-401-4363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-17
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty