Provider Demographics
NPI:1497455067
Name:SKILLS LICENSED BEHAVIOR ANALYST PLLC
Entity Type:Organization
Organization Name:SKILLS LICENSED BEHAVIOR ANALYST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:MELBER
Authorized Official - Suffix:
Authorized Official - Credentials:MS BCBA LBA
Authorized Official - Phone:732-668-9731
Mailing Address - Street 1:11 RED ROCK RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-2105
Mailing Address - Country:US
Mailing Address - Phone:732-668-9731
Mailing Address - Fax:
Practice Address - Street 1:11 RED ROCK RD
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-2105
Practice Address - Country:US
Practice Address - Phone:732-668-9731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty