Provider Demographics
NPI:1285006270
Name:PEDIATRIC THERAPY STUDIO
Entity Type:Organization
Organization Name:PEDIATRIC THERAPY STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ABA THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORRENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-312-3090
Mailing Address - Street 1:1201 S COURTHOUSE RD
Mailing Address - Street 2:#332
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-0812
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2106 GALLOWS RD
Practice Address - Street 2:SUITE E
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3961
Practice Address - Country:US
Practice Address - Phone:571-766-8455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health