Individual
SHALYSA ANNITA CHILDRESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, BCBA
Contact information
Practice address
1255 E 31ST ST, BROOKLYN, NY 11210-4740
(888) 320-3222
Mailing address
1255 E 31ST ST, BROOKLYN, NY 11210-4740
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-19-39348
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0046179
—
OH
01
—
1-19-39348
BCBA CERTIFICATE
—
Enumeration date
12/20/2018
Last updated
05/27/2025
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