Provider Demographics
NPI:1710385323
Name:THE GREGORY CENTER FOR APPLIED BEHAVIOR ANALYSIS
Entity Type:Organization
Organization Name:THE GREGORY CENTER FOR APPLIED BEHAVIOR ANALYSIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBS
Authorized Official - Phone:570-335-0357
Mailing Address - Street 1:17 STARK ST
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-2026
Mailing Address - Country:US
Mailing Address - Phone:570-335-0357
Mailing Address - Fax:
Practice Address - Street 1:17 STARK ST
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-2026
Practice Address - Country:US
Practice Address - Phone:570-335-0357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH00047103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty