Provider Demographics
NPI:1508451865
Name:ROOTS APPLIED BEHAVIOR ANALYSIS AUTISM TREATMENT CENTER
Entity Type:Organization
Organization Name:ROOTS APPLIED BEHAVIOR ANALYSIS AUTISM TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDENER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA-D
Authorized Official - Phone:973-362-8484
Mailing Address - Street 1:108 W VALLEY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:CALIFON
Mailing Address - State:NJ
Mailing Address - Zip Code:07830-3525
Mailing Address - Country:US
Mailing Address - Phone:973-362-8484
Mailing Address - Fax:
Practice Address - Street 1:185 RIDGEDALE AVE STE 107
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-1812
Practice Address - Country:US
Practice Address - Phone:973-362-8484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty