Provider Demographics
NPI:1609129121
Name:SPECTRUM ABA SERVICES LLC
Entity Type:Organization
Organization Name:SPECTRUM ABA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER, BUSINESS DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BESWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-500-5484
Mailing Address - Street 1:12 E RAMAPO AVE
Mailing Address - Street 2:#842
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-7000
Mailing Address - Country:US
Mailing Address - Phone:201-500-5484
Mailing Address - Fax:
Practice Address - Street 1:857 DARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-2528
Practice Address - Country:US
Practice Address - Phone:201-500-5484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-09-5649251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health