Provider Demographics
NPI:1205207800
Name:INNOVATION BEHAVIOR SERVICES, LLC
Entity Type:Organization
Organization Name:INNOVATION BEHAVIOR SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:302-244-3404
Mailing Address - Street 1:39 BANGOR ST
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-1711
Mailing Address - Country:US
Mailing Address - Phone:302-244-3404
Mailing Address - Fax:855-596-2438
Practice Address - Street 1:1474 E LEBANON RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-5833
Practice Address - Country:US
Practice Address - Phone:302-244-3404
Practice Address - Fax:855-596-2438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2015606572251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
12672941OtherCAQH
1639596174OtherNPI
1295235448OtherNPI
14217958OtherCAQH
14002656OtherCAQH
136117681OtherCAQH
1144653981OtherNPI
1962937540OtherNPI