Provider Demographics
NPI:1083301634
Name:INNOVATIVE ABA
Entity Type:Organization
Organization Name:INNOVATIVE ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KNOPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:732-691-1299
Mailing Address - Street 1:2432 BROOKHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-6850
Mailing Address - Country:US
Mailing Address - Phone:732-691-1299
Mailing Address - Fax:
Practice Address - Street 1:2432 BROOKHAVEN DR
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-6850
Practice Address - Country:US
Practice Address - Phone:732-691-1299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty