Provider Demographics
NPI:1093164691
Name:HYBRIDGE LEARNING GROUP LLC
Entity Type:Organization
Organization Name:HYBRIDGE LEARNING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-455-2600
Mailing Address - Street 1:100 FRANKLIN SQUARE DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-4109
Mailing Address - Country:US
Mailing Address - Phone:908-917-2552
Mailing Address - Fax:908-271-7110
Practice Address - Street 1:625 BARKSDALE RD
Practice Address - Street 2:SUITE 113
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-4535
Practice Address - Country:US
Practice Address - Phone:302-455-2600
Practice Address - Fax:302-439-1185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE67842Medicaid