NPIMap

Organization Active NPI

Impact Licensed Behavior Analysis PLLC

  • Behavior Analyst
  • Brooklyn, NY
National Provider Identifier
1205690203
Registry record updated Feb 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
IMPACT LICENSED BEHAVIOR ANALYSIS PLLC
Practice address
134 Stockton St Apt 2B
Brooklyn, NY 11206-5688
Phone
(718) 963-0007
NPI assigned
Feb 9, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Judy Roth, MSED, BCBA, LBANPI 1295263184
Title
Ceo
Phone
(718) 963-0007

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X Primary
Assistant Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 106E00000X
Behavior TechnicianGroup: 193200000X MULTI-SPECIALTY GROUP 106S00000X

Addresses

Primary practice location

134 Stockton St Apt 2B
Brooklyn, NY 11206-5688

Mailing address

134 Stockton St Apt 2B
Brooklyn, NY 11206-5688

Other names 1

  • Impact Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1707436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707696000000",
    "number": "1205690203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 STOCKTON ST APT 2B",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112065688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 STOCKTON ST APT 2B",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112065688",
            "telephone_number": "718-963-0007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT LICENSED BEHAVIOR ANALYSIS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-09",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A",
        "authorized_official_last_name": "ROTH",
        "authorized_official_first_name": "JUDY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "718-963-0007",
        "authorized_official_credential": "MSED, BCBA, LBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Assistant Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Impact",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Impact",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.