Provider Demographics
NPI:1073066536
Name:COMMUNITY BEHAVIOR CONSULTING, LLC
Entity Type:Organization
Organization Name:COMMUNITY BEHAVIOR CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:973-444-3304
Mailing Address - Street 1:364 BEECHSPRING RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1512
Mailing Address - Country:US
Mailing Address - Phone:973-444-3304
Mailing Address - Fax:
Practice Address - Street 1:364 BEECHSPRING RD
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-1512
Practice Address - Country:US
Practice Address - Phone:973-444-3304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY BEHAVIOR CONSULTING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-08-4393103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty