Provider Demographics
NPI:1538855796
Name:BRIAN GOLDMAN LICENSED BEHAVIORAL ANALYSIS PLLC
Entity type:Organization
Organization Name:BRIAN GOLDMAN LICENSED BEHAVIORAL ANALYSIS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:516-376-2055
Mailing Address - Street 1:35 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST WILLISTON
Mailing Address - State:NY
Mailing Address - Zip Code:11596-2424
Mailing Address - Country:US
Mailing Address - Phone:516-376-2055
Mailing Address - Fax:800-874-0959
Practice Address - Street 1:35 LEE AVE
Practice Address - Street 2:
Practice Address - City:EAST WILLISTON
Practice Address - State:NY
Practice Address - Zip Code:11596-2424
Practice Address - Country:US
Practice Address - Phone:516-376-2055
Practice Address - Fax:800-874-0959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty