Samira Dervisevic Rezika, MSED, BCBA, NYS LBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

002145 Issued in NY

Practice address

2324 Jerome Ave
Brooklyn, NY 11235-2801

Phone

(718) 646-7410

NPI assigned

Jun 15, 2012

Last updated

Sep 14, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1339718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726272000000",
    "number": "1770845620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2324 JEROME AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112352801",
            "telephone_number": "917-518-4266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2324 JEROME AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112352801",
            "telephone_number": "718-646-7410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERVISEVIC REZIKA",
        "first_name": "SAMIRA",
        "name_prefix": "Mrs.",
        "credential": "MSED, BCBA, NYS LBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-15",
        "last_updated": "2024-09-14",
        "certification_date": "2024-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "1176658",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NY",
            "license": "002145",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Derry Vick, PHD
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• Alexandra Derujinsky Selnick
• Muriel Dervich
• Richard Faator Dery, MD
• Alan Derzie, MD
• Stacy Derzie
• Mallory Des Champs
• Victoria Des Vignes

• Behavior Analyst in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Behavior Analyst in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 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.