Provider Demographics
NPI:1730706391
Name:LIGHTHOUSE BEHAVIOR ANALYSTS, PLLC
Entity type:Organization
Organization Name:LIGHTHOUSE BEHAVIOR ANALYSTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOPIN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:646-675-4945
Mailing Address - Street 1:13636 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2328
Mailing Address - Country:US
Mailing Address - Phone:646-675-4945
Mailing Address - Fax:
Practice Address - Street 1:13636 72ND AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2328
Practice Address - Country:US
Practice Address - Phone:646-675-4945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-30
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001604-1OtherSTATE LICENSE