# FUNCTIONAL DEVELOPMENT LICENSED BEHAVIORAL ANALYST LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821831371
- **Authorized official:** GANNA BARTASHEVA (OWNER)
- **Authorized official phone:** (718) 415-9046

## Contact information

- **Practice address:** 4 MUNCEE CT, HOLMDEL, NJ 07733-1246
- **Practice address phone:** (718) 415-9046
- **Mailing address:** 4 MUNCEE CT, HOLMDEL, NJ 07733-1246

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103K00000X | Behavior Analyst | — | — | Yes |

## Other

- **Enumeration date:** 06/13/2024
- **Last updated:** 06/13/2024