Provider Demographics
NPI:1114702651
Name:JERSEY BEHAVIOR CONSULTING LLC
Entity Type:Organization
Organization Name:JERSEY BEHAVIOR CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA, IBA
Authorized Official - Phone:609-760-5096
Mailing Address - Street 1:2007 PROSPECT RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1026
Mailing Address - Country:US
Mailing Address - Phone:609-760-5096
Mailing Address - Fax:
Practice Address - Street 1:2007 PROSPECT RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1026
Practice Address - Country:US
Practice Address - Phone:609-760-5096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty