Individual
SAMANTA ANNE TAKAZATO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED, BCBA, LBA
Contact information
Practice address
6214 24TH AVE, BROOKLYN, NY 11204-3319
(212) 481-4040
Mailing address
222 EARHART AVE, BARKSDALE AFB, LA 71110-2226
(240) 222-2699
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
L-648
LA
Other
Enumeration date
08/27/2017
Last updated
09/13/2024
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