Individual
BLAKE SLATER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, BCBA, LBA
Contact information
Practice address
16 CEDAR RD, EAST NORTHPORT, NY 11731-4033
(631) 987-9273
Mailing address
16 CEDAR RD, EAST NORTHPORT, NY 11731-4033
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
002216-01
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002216-01
LICENSED BEHAVIOR ANALYST
NY
Enumeration date
09/19/2022
Last updated
09/19/2022
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