1841579075 NPI number — DR. JENNY ELLEN LA BARBERA PSY.D., BCBA-D, LBA

Table of content: DR. JENNY ELLEN LA BARBERA PSY.D., BCBA-D, LBA (NPI 1841579075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841579075 NPI number — DR. JENNY ELLEN LA BARBERA PSY.D., BCBA-D, LBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LA BARBERA
Provider First Name:
JENNY
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D., BCBA-D, LBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TUZIKOW
Provider Other First Name:
JENNY
Provider Other Middle Name:
ELLEN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSY.D., BCBA-D, LBA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841579075
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
510 E 23RD ST
Provider Second Line Business Mailing Address:
APT. 5B
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10010-5012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-749-2403
Provider Business Mailing Address Fax Number:
347-527-9170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
248 E 49TH ST
Provider Second Line Business Practice Location Address:
SUITE 1B
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10017-1548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-749-2403
Provider Business Practice Location Address Fax Number:
347-527-9170
Provider Enumeration Date:
08/05/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-07-3960 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X , with the licence number: 000406 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: 018399 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)