Provider Demographics
NPI:1891148227
Name:MASTERMIND BEHAVIOR SERVICES
Entity Type:Organization
Organization Name:MASTERMIND BEHAVIOR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAIZY
Authorized Official - Middle Name:
Authorized Official - Last Name:PERLSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:732-367-0781
Mailing Address - Street 1:204 HADASSAH LN
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5562
Mailing Address - Country:US
Mailing Address - Phone:732-367-0781
Mailing Address - Fax:732-367-0781
Practice Address - Street 1:204 HADASSAH LN
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5562
Practice Address - Country:US
Practice Address - Phone:732-367-0781
Practice Address - Fax:732-367-0781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0450090137103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty