Provider Demographics
NPI:1174386510
Name:CBG LICENSED BEHAVIOR ANALYSIS PLLC
Entity type:Organization
Organization Name:CBG LICENSED BEHAVIOR ANALYSIS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAIM
Authorized Official - Middle Name:B
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:845-422-1958
Mailing Address - Street 1:3 OAK GLEN RD
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-3646
Mailing Address - Country:US
Mailing Address - Phone:845-422-1958
Mailing Address - Fax:
Practice Address - Street 1:3 OAK GLEN RD
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-3646
Practice Address - Country:US
Practice Address - Phone:845-422-1958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty