Provider Demographics
NPI:1861953283
Name:GOTHAM CHILDREN LICENSED BEHAVIOR ANALYSTS PC
Entity type:Organization
Organization Name:GOTHAM CHILDREN LICENSED BEHAVIOR ANALYSTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CASSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-875-8853
Mailing Address - Street 1:225 BROADWAY STE 2710
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-3032
Mailing Address - Country:US
Mailing Address - Phone:646-875-8853
Mailing Address - Fax:
Practice Address - Street 1:225 BROADWAY STE 2710
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-3032
Practice Address - Country:US
Practice Address - Phone:646-875-8853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-28
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty