Provider Demographics
NPI:1760802326
Name:PEDIATRIC BEHAVIORAL SOLUTIONS, LLC
Entity Type:Organization
Organization Name:PEDIATRIC BEHAVIORAL SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAININE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:609-384-0040
Mailing Address - Street 1:1065 BUCCANEER LN
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2018
Mailing Address - Country:US
Mailing Address - Phone:609-384-0040
Mailing Address - Fax:
Practice Address - Street 1:1065 BUCCANEER LN
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2018
Practice Address - Country:US
Practice Address - Phone:609-384-0040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health