Provider Demographics
NPI:1275029985
Name:THE SPECIAL EDUCATION TEACHER LLC
Entity Type:Organization
Organization Name:THE SPECIAL EDUCATION TEACHER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-277-3392
Mailing Address - Street 1:147 FORD AVE
Mailing Address - Street 2:
Mailing Address - City:FORDS
Mailing Address - State:NJ
Mailing Address - Zip Code:08863-1622
Mailing Address - Country:US
Mailing Address - Phone:732-934-5402
Mailing Address - Fax:908-379-3286
Practice Address - Street 1:147 FORD AVE
Practice Address - Street 2:
Practice Address - City:FORDS
Practice Address - State:NJ
Practice Address - Zip Code:08863-1622
Practice Address - Country:US
Practice Address - Phone:732-934-5402
Practice Address - Fax:908-379-3286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty